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hoc. .�Ac RD �'� APPLICATION USINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> MAY. 0 2009 BUSINESS LICENSE NO. e::5O <br /> �rFOFt <br /> TO BEC f THE ANT P 'AOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: v <br /> Business Address: 59 Cross St � <br /> DBA Mailing Address:�f�4 D l T1 City: State: ZIP- r <br /> Phone#: `LQ — 3 Assessor Parcel Number(s): j �- <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation "•❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: (p <br /> Applicant Last Name-- N Applicant First Name: Cu Q,t) }eye p L, A • , <br /> Applicant Mailing Address: - CA . <br /> City L State ZIP I Applicant Phone No: 01LiC1 G <br /> (11 <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,all the above information is true and correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: G Zoning: Use Type:, r� u l <br /> DEPARTME=NT APPROVED DENIED DATE: <br /> Development Services Planner Name: �-- <br /> Building Inspection <br /> Environmental Health Div e <br /> I <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: L)r --}-- <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> FADevSvcT1anning Application Forms\Business License(Revised 05-0]-08) Page 2 of 7 <br />