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IF-to-.0-o(y <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />7 , <br />BUSINESS LICENSE NO..7-)l. <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: <br />Business Address: P K Cross St <br />DBA Mailing Address: City: Lodi State: CA <br />I ZIP: G <br />Phone #: _ Assessor Parcel Number(s): <br />Email: m <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: Q N <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: E <br />Applicant Mailing Address: 1301 W. <br />City LpA i I State CA ZIP Applicant Phone No: UCY— LA <br />Water Supply: ®Public ❑ On-site Well Sewage Disposal: IK Public ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes Cd No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all the above information Is true and correct <br />1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its <br />agents, officers and employees from any claim, action or proceeding against the County <br />arising from the Owner/Agent's project. <br />Applicant's Signature: <br />Date: <br />0 <br />STAFF USE ONLY <br />G/P Designation: Zoning: - Use Type: <br />DEPARTMEN APPROVED DENIED AT <br />Development Services Planner Name: <br />Building Inspection <br />Environmental Health Div �' J <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For <br />Remarks:',�Jl _ <br />Om Grp. <br />Accepted as Complete: Date: <br />F:1DevSvc%Planning Application ForrnsWusiness License (Revised 01-25-10) Page 2 of 7 <br />