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P4"'" APPLICATION — BUSINESS LICENSE <br /> q SAN. JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �� '• �' t' e `��� / BUSINESS LICENSE NO. r L'0b1 U 1 CA <br /> MW <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Tl Ss <br /> Business Address: M,p �pj Cross St <br /> DBA Mailing Address: Q ( A j City: LOG4L:.�I2State: ZIP: 023 <br /> Phone#�30.) 311'jY c)- cj Assessor Parcel Number(s): Z� — <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: gyp, <br /> Type of Business: L l p, CiL-k-V- -Gt (2-.,2 <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employe s: &Wed Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: MeApplicant First Name: 416M b ' <br /> Applicant Mailing Address: P ` 0 G` �jl <br /> City AVIS State C)-A I ZIPgG6[ Applicant Phone No: j30 041- Q 9 c�), <br /> Water Supply: ❑Public ❑ On-sit Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ es V No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above information is rue and correct Date: <br /> Applicant's Signatures 477;�� OL-, <br /> STAFF USE ONLY <br /> G/P Designation: Zonin : Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: (P 0 <br /> Building Inspection <br /> Environmental Health Div v J jvlk �•, <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: Q ' a- V <br /> 0_10 r U r s hI v`�22 <br /> Remarks: S a c4o or S S - vt <br /> Occ.Grp. <br /> Accepted as Complete: _ Date: <br /> F:\DevSvc\Planning Application Forms\Business L cense(Revised 05-01-08) Page 2 of 7 <br />