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APPLICATION - BUSI- ttE <br /> r' y SAN aQAQ�11N COUNTY COMMUNITY DEVELOPMENT DEPARii <br /> IIENT <br /> y'bit <br /> BUSINESS LICENSE NO.04 APR 27 <br /> c•.• y- �P <br /> 9�/FORD <br /> TO BE COMPL TED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address: % T Cross Std <br /> Mailing Address: City: r State: ZIP: <br /> Phone#: Qli ��`� Assessor Parcel Number(s): <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: x"4x <br /> Type of Organization: Single Pwner ❑ Partnership ❑ Corporation ❑ Other- <br /> Estimated <br /> therEstimated Number of Full Time Em loyees: Estimated Number of Part Time or Seasonal Employees: % <br /> Applicant Last Name: D1 IO Applicant First Name: ��y/`= <br /> Applicant Address: e-14, "– % `[/ 11'11 <br /> City I State(, ZIP Applicant Phone No: p / <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Pu lic Septic System <br /> Will there be any sale of firearms? ❑ Yes 91No <br /> NOTE: ANY CHANGE OF OCCU AN Y MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> Applicant's Signature: Date: <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: — ln/ Use Type: r.% – <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For: <br /> S ✓ ✓�� <br /> Remarks: <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forrns\Bt siness License(Revised 12-31-02) Page 3 of 8 <br />