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ontrol No. Ilf �I <br /> B. L. No. 2/ <br /> G� • <br /> Date Licensed- = �•�� " <f-' Receipt No. _ <br /> SAN JOAQUIN COUNTY - <br /> BUSINESS LICENSE APPLICATION <br /> (Please print or type) <br /> 1. Business Name i..r� ./ D /'-A-74 ria V / Phone �Z. 5-2-- <br /> 2. Business Address ZI,4 �- <br /> (address) _ (city) <br /> (zip)code) <br /> 3. Mailing Address <br /> (address) �'� 9y � <br /> (city) (zip code) <br /> 4. Description of Business <br /> 5. Type of Organization: single owner, �E]partnership, ❑ corporation <br /> 6. Estimate Number of Employees: full time -- -- part time or seasonal <br /> 7. Owner(s) Home Address '- =i,, :.,.,,t?;a Phone -.`1j7.2/2 172 <br /> 8. Manager's Name (if corporation) Phone <br /> 9. Previous Owner's Name <br /> 10. Other Local Business Addresses - --i -� <br /> 11. Is there another business at this location? <br /> I hereby certify under penalty of perjury that the above information is true and correct to the best of my knowledge and <br /> belief. <br /> (Ap'plicant's Signature) <br /> . - y .� / �''�•/ice--��--'� <br /> (Date) (Phone) <br /> FOR COUNTY USE ONLY <br /> COPIES DEPARTMENT BY DATE REMARKS 1 <br /> (White) Planning Department <br /> (RILL)_-, Ri.iilrhina lncnnrtnr <br /> (Green) Fire Warden <br /> (Goldenrod) Public,Works <br /> L---LPt<) Local Health District / <br /> (Canary) Final Approval <br /> Assessor's Parcel Numbers) /yf'�`O %� �,3-�� <br /> Zone ��� <br /> •y 00 <br /> Activity Code(s) r <br /> j ';.q_ p <br /> Property Address L �`-t 15-1 Z16"I I L! <br /> (No.) (D r.) (Street Name) N <br /> � o <br /> �`"" _..�- r x`�y'�r ''�s a.,a�e' 6i+%���a$�a-�n�i;^•""'��s:r.,;ti�ee .�' k+�."c'"�":9rs-�.'r"�y ".��"-.�. -�,."'"°sr`��_. <br />