Laserfiche WebLink
,..........- .-sl, z-- —,t...--, • <br />Zii '\ i:'< <br />• <br />APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. /3/. — n o 6/y3 <br />isteb <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: C.‘0\1,..) Q1 Qm k.,\ tm.,./),e. (...L. (_ <br />Business Address: (Z;(: 1 \...1t Om( \k Q...4•Jv Cross St <br />DBA Mailing Address: S kucL, City: 51c,,,,i.A., state: ( A ZIP: ci S't t c <br />Phone #: ).t ,A CO \ -LS .z, Assessor Parcel Number(s): 1 -3 1 ---. 2. 2 6 - 0 A <br />Email: -•,S,,,,..., M 6s..1'k ,n, . 1/4. <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />i\\\sks 1 rA. <br />Type of Organization: 0 Single Owner 0 Partnership 0 Corporation 0 Other: <br />Estimated Number of Full Time Employees: 1 - ‘, 1. - Estimated Number of Part Time or Seasonal Employees: 1_ 5 <br />Applicant Last Name: 6,,,,OINNe, r, Applicant First Name: L a ( A <br />Applicant <br />* <br /> Mailing Address: Six,svsk.... <br />Supply: [Public 0 On-site Well <br />State ZIP Applicant Phone No: y z s <br />Sewage Disposal: D Public 0 Septic System <br />Will there be any sale of firearms? 0 Yes 2)/ No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all the above information is true and correct <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 project. <br />— <br />Applicant's Signature: \ AK' <br />Date: ihk t -s i i t <br />A J STAFF USE ONLY <br />G/P Designation: Zoning: _A-qo 1 _ Use Type: (-Lie c/, ion k 0,.(//A <br />DEPARTMENT APPROVED DENIED DATE <br />Development Services <br />17 Planner Name: <br />Building Inspection <br />Environmental Health Div V 4:I CI ,O 6i61/( <br />Fire Warden 53-C Sit 00o (-72 0 <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />ft? a c mei <br />Rip: I <br />Occ. Grp. <br />Accepted as Complete: 1 Date: <br />FAIDevSvc\Planning Application Forrns\Business License (Revised 01-25-10) Page 2 of 7