Laserfiche WebLink
,°P4�" ° APPLICATION - BUSINESS LICENSE <br /> .--- <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; <br /> BUSINESS LICENSE NO.- <br /> QAC/FORN`P (�J�Ln <br /> �II V W1}ff1' �7-�'-� -. <br /> L TO BE COMPLRTrFA B,yAl� P"CANT PRIOR TO FILING THE APPLICATION <br /> f k ALTH DEPA32 k{@Htess Informat b .; <br /> Business Name:3 Ve .<-Abfrto TAZA <br /> ------.. <br /> Business Address: 14744 k/ 71ro9-t,7rb U R9 Cross St NWY 12 5 <br /> DBA Mailing Address: .p rbCX Q_6g,V- city: /pZ,•. . slater Cf� 4.? <br /> Phone Phone#: 2eq- 36 8100 Assessor Parcel Number(s): _ Q . <br /> Other Businesses at this Address: - <br /> Previous Business at Address: - - <br /> Type ofBuslness: 'f)fpSCI <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: - <br /> Applicant Last Name:kN,�. p Applicant First Name: <br /> Tom\ <br /> Applicant Mailing Address: -D 'gam 26cl` <br /> city 1 srate CA zllzt� Applicant Phone No: l — 321�2rj o a— <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ PublicSeptic System <br /> Will there be any sate of firearms? ❑ Yes ErNo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above Information is true and correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: C yCS Zoning: -jr'S Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services t/ Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: L -7.5 <br /> /C <br /> - /)Wt 0. o <br /> Occ,Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Fonns\Business License(Revised 07-26-04) Page 3 of 8 <br />