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0 -, APPLICATION, �- BUSINESS LICENSE <br /> • •.o <br /> r i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. �Z <br /> �9F•i� .e�+``- ;�aJVlli N'lil�ii.-Ll1;11.III_�1l.VI <br /> TO BE CONIPL TED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: L'' 2 C. <br /> Business Address: tK ` T Cross St <br /> DBA Mailing Address: City: Stale: ZIP:`Ir <br /> Phone#: a cJ`I - &119I Assessor Parcel Number(s): o (5�. <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: I <br /> Description of Business Operation:: Ce <br /> Type of Organization: ❑ Single O er ❑ Partnership (Eq Corporation ❑ Other. <br /> Estimated Number of Full Time Emplo ees: 4 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: ( �, Applicant First Name: Cora- <br /> Applicant Mailing Address: 8a �� .� Q <br /> City J— Ca St to GA ZIP c r')>>%7Cj Applicant Phone No:(Cl �j par <br /> Water Supply: ❑Public (gp On ite Well Sewage Disposal: ❑ Public (W Septic System <br /> Will there be any sale of flr arms? Yes No <br /> NOTE: ANY CHANGE OF OCCUPA CY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm, under penaltLent's <br /> at all the above information Is true and correct Date: <br /> I,the Owner/Agent ag , Indemnify,and hold harmless the County and its <br /> agents,officers and am any claim,action or proceeding against the County <br /> arising from the Ownee <br /> Appllcanl's Signature: <br /> TAFF USE ONLY <br /> G/PDesignation: liomZon ng: Use Ty e: S S <br /> DEPARTMENT AP ROVED DENIED DATE <br /> Development Services Planner Name <br /> Building inspection <br /> Environmental Health Div <br /> Fire Warden Ir <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved <br /> Remarks:Co aas <br /> Oce.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/Planning plications/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />