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APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. L- Lai oOL 3 ► <br /> COMPLETED^BY THE APPLICANT PRIOR TO FILING.THE APPLICATION <br /> ,. <br /> Business Information' <br /> Business Name: pip r�^ Ol LLC. <br /> Business Address: V Al /I ; oed, Cross St <br /> DBA Mailing Address: f. pv/ , City: State: L'9 ZIP:�ff2 y <br /> Phone#: Z pr _ <br /> L6 L Assessor Parcel Number(s): ns <br /> Email: a, p/`p fgvG' t7y� I96 <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: 0 <br /> Type of Organization: ❑ Single Owner ,Q�Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 11W Applicant First Name: rf <br /> Applicant Mailing Address: app E �j-A-Ma wql , <br /> city State ell ZIP SZ1 Applicant Phone No: L2e 1-?e<-49217 <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public K Septic System <br /> Will there be any sale of firearms? ❑ Yes X No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above i r tion i true and correct Date: <br /> Applicant's Signature: <I 5/0/p 7 <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: _ v Use Type: <br /> DEPARTMENT A ROVED DENIED E <br /> Development Services Planner Name: <br /> Building Inspection Ge i iti <br /> Environmental Health Div LKS �Li <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: J <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc'Planning Application Forms\Business License(Revised 08-30-06) Page 2 Of 7 <br />