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( COMMUNITY DEVELOPMENT DEPARTMENT
<br /> SAW.JOAQU BUSINESS LICENSE
<br /> COUNTY—
<br /> FILE NUMBER:
<br /> Greatness :grows he�'», Resp e D e ate:
<br /> FOR STAFF USE ONLY •) j
<br /> Business Information Applicant Information, ! 1
<br /> Business (DBA) Name_ Name: 51r11r6A S uk Ck
<br /> _— —
<br /> g � - - —�� --_ a_ 0 6A" g 6 s 7S PVR 4(.E �/� D
<br /> Mailing Address: '���I � n(� /�/3ri•,{�,c. � r' Mailing Address:
<br /> -Phone -__U 7_3._..__ t!3 � C R Phone: 16_'7(- 4t2
<br /> Wit . I? _.
<br /> Email: f1ILL13 A r_K CEmail:syk oto,:-t Swou Lo A"VylGlt . CCSY`',
<br /> Property Information
<br /> ' Assessor Parcel Number Property Address FCity Cross Street
<br /> G ZSp2`D9 0 170 s( Esc.aco �3c-(.c v� c A.&0 A) AV'
<br /> Business Details
<br /> G -Description of Business: G-OLF_CDV _—
<br /> --.. _... .._...-
<br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑Other:
<br /> Does the business include the sale of firearms? ❑Yes JR No
<br /> Number of Employees Hours of Operation Water Service Sewer Service
<br /> Full Time Part Time S Public Private(on-site) Public 1 Private(on-site)
<br /> NOTE:ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> AUTHORIZATION SIGNATURES
<br /> I,the Owner/Applicant/Agent,agrees to indemnify,defend(with counsel reasonably approved by County),and hold harmless the County and its officers,officials,
<br /> employees,agents,boards and commissions(collectively"County")as follows:
<br /> 1. INDEMNITY:
<br /> A.From and against any and all claims,demands,actions,proceedings,lawsuits,losses,damages,judgments and/or liabilities arising out of,related to,or in
<br /> connection with the application and applied for project or to attack,set aside,void,or annul,in whole or in part,an approval of the applied for project by the
<br /> County,the adoption of environmental review documents related to the applied for project,and any related development approvals or project conditions for
<br /> the applied for project(hereinafter"Claim");
<br /> B.For any and all costs and expenses incurred by the County on account of any Claim,except where such indemnification is prohibited by law,including but
<br /> not limited to damages,costs,expenses,attorney's fees,or expert witness costs that may be asserted by any person or entity,private attorney general fees
<br /> claimed by or awarded to any party against the County,and the County's costs incurred in preparing an administrative record which are not paid by the
<br /> petitioner.
<br /> C.Except as to the County's sole negligence or willful misconduct.
<br /> 2. DEFENSE:
<br /> A.The County may participate or direct the defense of any Claim.The County's actions in defense of any claim shall not relieve me of any obligation to
<br /> indemnify,defend,and hold harmless the County.
<br /> B.In the event of a disagreement between County and me regarding defense of any Claim,the County shall have the authority to control the litigation and
<br /> make litigation decisions,including,but not limited to-the manner in which the defense is conducted.
<br /> C.If I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County,then County may utilize the Office
<br /> of the County Counsel or employ separate outside counsel to represent or defend the County,and I shall pay the reasonable attomeys'fees and costs of
<br /> such counsel.
<br /> I,the Owner/Applicant/Agent,affirm all the information above is true and correct,under enqlty of perjury.
<br /> Print Name: ���/�Ll SU(Z`C Signature: Date: O
<br /> FOR STAFF USE ONLY
<br /> General Plan Designation: _ Zoning Designation: R— Lt,) Use Type:
<br /> Department Approved Denied __ � Signature Date
<br /> CDD:PlanningDivision
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<br /> Building Division
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<br /> Enforcement Div ion
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<br /> Fire District/Warden:
<br /> ... -- -- _
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<br /> Environmental Health Department - S U 00 1 3 O CO--4--
<br /> _-_ SB 1 • (D oZ 02
<br /> .......... ..._ .._. .... _. _.
<br /> Department of Public Works
<br /> ......._..........__....................._..............__.. ....... ......----.._-------------........----
<br /> MHCSD(if applicable)
<br /> License approved for.. r cis
<br /> _...._.........._____.... .....___.............'�,,,..,�._au�._ _......1. ..eCLS�...C�. .. ..1.►.C.. i. --------
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<br /> �Yj..
<br /> History: ''
<br /> Finalized by: Date
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