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APPLICATION - BUSINESS LICENSE
<br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br />BUSINESS LICENSE NO eq °L) I
<br />
<br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION
<br />Business Information
<br />Business Name: W Ki7b—T 7-1 z ( 4 6 /T., c.s f SC Aft i'Ll - 0 6,) •1
<br />Business Adaress-gro3 ij ej i „i d,,,,. V j /0c/..--/ai Cross St A/D hi--
<br />MA Mailing Address: cpv it) ev 624 a c_./ #1,, City -A, rt CA. ik-4 0A a A I< , State. X/ ZIP: // .›. ,.)
<br />Phone #• g 1 9.0? 3 i t/1 0 I Assessor Parcel Number(s):
<br />I 3 t — 9\ .1) —
<br />Email: a 6, t 74i-1,691Ac7 rI -
<br />Other Businesses at this Address:
<br />Previous Business at Address. /1-(7,/ l--- Po k 6.4„-, 01
<br />Type of Business. , , ____ __._ ...NI
<br />...) --
<br />Type of Organization. 0 Single Owner 0 Partnership 0-"t orporation n Other
<br />Estimated Number of Full Time Employees 3 Estimated Number of Part Time or Seasonal Employees: pea e___
<br />Applicant Last Name: 6 6,r;_70 /4z,e/C Applicant First Name
<br />Applicant Mailing Address:SS-0 3 a...) ,;(..;,d,,,-,; // S /0 ( ,'' fi, v7 (r9 /, 1;1.--4-1-c
<br />City S 10C- K FO V1 State C i4 ZIP .),„) 6' Applicant Phone No: e ,s7 -- ci 2 3 /(-7/6-) 0
<br />Water Supply DPublic 55, On-site Well Sewage Disposal: E Public A Septic System
<br />Will there be any sale of firearms? 0 Yes iiii. No
<br />NOTE: ANY CHANGE OF OCCUPANCY AY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br />I, affirm, all the ab infor r e a d correct
<br />Applicant Signat ,
<br />
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<br />'s
<br />Date: 7-
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<br />t STAFF USE ONLY
<br />G/P Designation: D s f....t, Zoning: A. LI- 0 Use Type EV:UP/1201r ,_sd fe,i 1- rep a ir - /2 j s
<br />v 7_._—.
<br />DATE DEPARTMENT APPROVED DENIED
<br />Devs!opment Services Planner Name yyl ti-a:k.4.__ 111;2.ii101
<br />Building Inspection
<br />Environmental Health Div --(Aii7, ...i/ /77 07
<br />Fire Warden
<br />Public Works APO or ,,Or _
<br />M H C.S.D.
<br />Sheriff (Junk Dealers Only)
<br />License Approved For: /5 L 1 tY b 0 a i i (Drets‹.- 7 /4e1., i 1- 0
<br />Remarks ifi, bocci s et I e_i - fl Sc rapyi p f rty? pit( d
<br />c) o uf3 1 Occ Grp.
<br />Datecepted Ac as CropirRietle.:„.., _ ,
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<br />OevSvOlpianning Applicaton Forms‘Business License (Revised 09-01-09)
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