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5-2i -2W 1(v <br /> APPLICATION - BUSINESS LICENSE <br /> MAY 0 6 2016 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> IFENARONMENTALHE&TH BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Gro-Well <br /> Business Address: 4343 S. McKinley Ave. Cr s St Industrial <br /> DBA Mailing Address: city: Stockton State: CA 95206 <br /> Phone#: 209-982-4936 Assessor Parcel Number(s): 193-020-09 <br /> Email: jredublo@gro-well.com <br /> Other Businesses at this Address: none <br /> Previous Business at Address: Sierra Organics <br /> Description of Business operation:: Bark mulch packaging <br /> Type of Organization: [3 Single Owner [I Partnership EX Corporation [I Other: <br /> Estimated Number of Full Time Employees: 33 Estimated Number of Part Time or Seasonal Employees: 2 <br /> Applicant Last Name: Redublo Applicant First Name: Jesus <br /> Applicant Mailing Address: 4343 S. McKinley Ave. <br /> City Stockton I state CA zip 95206 Applicant Phone No: 209-982-4936 <br /> Water Supply: []Public EX on-site Well I Public IN Septic System <br /> Will there be any sale of firearms? [3 Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under penalty of pequry that all the above information Is true and correct Date: <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 p jest. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: zoning: Use Type: C <br /> 2' y"p <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: (Y) - <br /> Building Inspection <br /> Environmental Health Div V 050 VO locw-1 <br /> Fire Wardenl92540i �ft7 <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For (YUluficft4- ,Jh-1'k)Ztf7 (Al-lj"Cezg!�Lj <br /> Occ.Grp, <br /> Accepted as Complete: Date: <br /> F/ApplicafionsForrns&Handouts/PlanningApplicarions/Businm License(Revised 02-24-15) <br /> Page 2 of 6 <br />