Laserfiche WebLink
;�� ulFY <br /> APPLICATION � BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 00 <br /> BUSINESS LICENSE NO , <br /> ! i v f Lq <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Ill a r� <br /> Business Address : .� Cross St ` n C <br /> 1A / <br /> DBA Mailin Address: City: <br /> .� frA � ,� � State: (.,f . ZIP: go oo <br /> Phone #: / / l j�U Y y� rr� Assessor Parcel Number(s) : Z � 2 <br /> Email 0 0! IIS � 6 IZI I C0 <br /> Other Bust esses at thisAddressIf <br /> : <br /> !1 "a <br /> Previous Business at Address : <br /> Description of Business Operation: : loo ,oh I i Ir <br /> If <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: if <br /> Estimated Number of Full Time Employees : Estimated Number of Part Time or Seasonal Employees : <br /> Applicant Last Name: r <br /> Applicant First Name: <br /> Applicant Mailing Address : <br /> City (� State CA� ZIP �� ' Applicant Phone No: <br /> Water Supply: ❑ Public ❑ On-site Well Sewage Disposal: ❑ Public <br /> ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE : ANY CHANGE OF OCCUPANCY MAY EQUIRE 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/Agent's projectood00000 <br /> Applicant's Signature: .' <br /> -STAFF USE ONLY <br /> G/P Designation : Zoning : — S Use T e: r� tt / <br /> yp ( Te4 / �t � F .4P ' n <br /> DEPARTMENT APPROVED DENIED <br /> Development Services DATE <br /> � / Planner Name: ' <br /> Building Inspection f � <br /> Environmental Health Div <br /> Fire Warden r <br /> Public Works <br /> M . H . C . S . D , <br /> License Approved For: _ -- <br /> Remarks: <br /> 0 o b `- ? NT Occ, Grp. <br /> Accep ed as Complete: y <br /> Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br /> Page 2 of 6 <br />