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RECEIVED <br /> APPLICATION - BUSINESS LOR <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT D�DERWNIU lTou <br /> p TY <br /> JC MERGENCYS CES <br /> BUSINESS LICENSE NO._'306ol <br /> �"4CiFo'iRN`p <br /> Tt/�OMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Naq ,fBusinessAd7 i ^/ Lod DBA Mailing �e cad .rm_ �� LOCM State: ZIP: )Sz510 <br /> Phone#: - / o Assessor Parcel Number(s): Q 0 S — 1(oo— 3 I <br /> Other Busineddress:Previous Busress:Type of Busi / <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Omer: <br /> Estimated Number of Full Time Employees: Z- Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: /� S�S Applicant Fust Name: <br /> Applicant Mailing Address: I3 (PD AJ. LorwX l %net. /1./. <br /> City ( �,, r 1 State --FZIPFS.2`fVj Applicant Phone No: ,p 3 - 73 <br /> Water Supply. ❑Pubfic On-site WellI Sewage Disposal: ❑ Public Septic System <br /> Will mere be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above Information is true and corre t Date: <br /> Applicant's Signature: I.S OS' <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: .� <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works - <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: ' <br /> Remarks: <br /> Dec.Grp. <br /> Accepted as Complete: Date: <br /> F1DevSvcXRanning Application Foons\Business License(Revised 07-28-04) Page 3 of 8 <br />