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— <br />e-1 1----1-4 ..-y v.,.\ ,\ ....., to: ' :.< <br />APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO./77)/. — Ii 0 ot-r‘ . ...1: <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: CA 0‘,...), \ Q1 Qbki v.‘ 0, e_ UL (_ <br />Business Address: (CI', C% 1 \....1 rnelmt \\ Q.. es/ V Cross St <br />DBA Mailing Address: S ki\ ..., City: 5 k 4 LO ,,--t State: (A ZIP: 1 Tj 0 c <br />Phone #: ).t0,c.\ c.,0 (4 Assessor Parcel Number(s): J 7 / - 2 . 2- 6 - 0 6 <br />Email: A, „ , t.! L , .• , re. <br />Other Businesses at this Address: <br />Previous Business at Address: Nn spo Vg,‘„,‘5 <br />Description of Business Operation:: <br />CI.,t N iNt. \) , -1—, <br />1 Type of Organization: D Single Owner 0 Partnership 0 Corporation 0 Other: <br />Estimated Number of Full Time Employees: r"S - S' Estimated Number of Part Time or Seasonal Employees: I_ 5 <br />Applicant Last Name: '10N,t.lk.\ 1,,,e, N Applicant First Name: 0 j A ( <br />Applicant Mailing Address: 6i c '..i CiNio,j.c <br />CAlk <br />State ZIP Applicant Phone No: q z_s. ) rs tq <br />upply: 0 Public 0 On-site Well Sewage Disposal: 0 Public 0 Septic System <br />Will there be any sale of firearms? 0 Yes 12( 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' \ V"---, <br />Date: A, I f <br />) <br />STAFF USE ONLY ini,i4, G/P Designation: - Zoning: A ‘- - Q o Use Type: il_ ‹-c /e7 6, fort :. PI ' <br />DEPARTMENT APPROVED DENIED DATE <br />Development Services Planner Name: 6.21_ <br />Building Inspection <br />i>. <br />e. ' <br />1-3_1‘i <br />_ _I( <br />Environmental Health Div X 6- /-/ i <br />Fire Warden .5,1-L. )(.C. <br />t9-itil di 1 ikitl4Via, <br />G- I 1- 1 ( <br />Public Works X <br />oz: 1 • -rti_421 <br />5- e03,- , 6,-C,- // m.H.C.S.D. <br />License Approved For: <br />ir) ei t Ill et. <br />RIDS: <br />OCC. Grp. <br />. Accepted as Complete: 0 - c9CeS(Cbtkp Date: ‘p i / 00/ i <br />FADevSvc1Plannin g Application Forms\ Business License (Revised 01-25-10) Page 2 of 7