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a�fML(C 1'( _ BUSINESSLICENSE <br /> `'.•. '�� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. /-- I , 00;L f 2— <br /> T 0 <br /> -,TO BE COMPLETED BY TME APPLICANT RIOR TO FILING—THE A PLICATIOPI . ' <br /> Business Information <br /> Business Name: A `t 1.sc.0�V p Veit, <br /> Business Address' L f 7 5 �. 4s . r'G E t, Mr St tt <br /> DBA Mailing Address: '` `�L`� a City., p State: ZIP: S 3 b <br /> I W1 (v Assessor Parcel Number(s): <br /> Email: CA",er <br /> Other Businesses at this 7J dress: J` <br /> Previous Business at Address: S <br /> Description of Business Operation:: <br /> � J <br /> s Type of Organization: 1ANingle Owner ❑ Partnership ❑ Corporation El Other. <br /> Estimated Number of Full Time Employees: —��j~ Estimated Number of Part Time or Seasonal Employees: CT` <br /> Applicant Last Name: N—(,- �J vpuz rz. Applicant First Name: eY <br /> Applicant Mailing Address: <br /> I City State ZIP ©I ,3"L plicant Phone No: -asn <br /> Water Supply: ❑Public On-site Well Sewage Disposal ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes 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 Date: <br /> I,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/Ag nVs p oject. <br /> Applicant's Signature: <br /> .STAFF USE ONLY <br /> G/PDesigna6on: Zoning: - 0 Use Type: /Q/)/ actcat� o/{/tfo . 4ay n <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div t1 ' <br /> Fire Warden eiAbl <br /> Public Works <br /> 3 M.H.CS.D. <br /> { License Approved For: <br /> i <br /> E <br /> i <br /> Remarks: <br /> i <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> I <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />