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RECEIVED <br /> a <br /> APPLICATION — BUSINESS o N <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPME <br /> a CY ERVICES <br /> �. BUSINESS LICENSE NO. <br /> giiKpH`'4 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: W01St2 ReCOV2f WQrj1 T-r)C• dbeA WRW,I C. <br /> Business Address: <br /> 4554 5 rideprin Si 2ilrMa f, 161 <br /> DBA Mailing Address: PO BOX 833x8 City: Ort larKl Stale: QR ZIP:q�a <br /> Phone p: 5o,3-a4o-iqiq Assessor Parcel Number(s): 3 - &.L& - <br /> Email N7'O < reC c� i 49 ply <br /> Other Businesses at this Address: <br /> Previous Business at Address: fllw,6p-- rs �u�.e yL n� <br /> Description of Business Operation:: <br /> Rbm-r &o 3 <br /> Type of Organization: ❑ Single Owner ❑ Partnership I& Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 8 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: f�,� Applicant First Name: 4,,L,/< <br /> Applicant Mailing Address: ��. 3o�-q g <br /> Cit 4 N State CA4 ZIP 7e2Applicant Phone No: 83— (Q— J f <br /> Water Supply: ublic ❑ On-site Well Sewage Disposal: ❑ Public $[Septic System <br /> Will there be any sale of firearms? ❑ Yes $4 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 Date: <br /> I,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its ?Ia 7�a <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's pro'ect. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: (i Zoning: �� Use Type: ( ,w <br /> DEPARTMENT APPR ED DENIED DATE <br /> Development Services Planner N <br /> Building Inspection O <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: .& Me-I'L- G.li e/ Z L- <br /> Y,- s d�� <br /> Remarks: 1 � 6� <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:OevSvc\Planning Application Forms\Business License(Revised 01.25-10) Page 2 of 7 <br />