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Our" APPLICATION - BUSINESS LICENSE <br /> Q: ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. 8Z 0(,,00 j`('�' <br /> ti€oat' <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: CO l_ 1_ I CA N b I1�+ <br /> Business Address: �1 S E. H W crnss.Rt " I <br /> 1� S <br /> DBA Mailing Address: . 0. 1 I 15(0 ! City: Lt')(.kEI= State: Cp ZIP. SZ <br /> Phone#.' `l - -, C'C' Assessor Parcel Number(s): (!5 ,.._Q go - <br /> Other Businesses at this Address: W <br /> Previous Business at Address: n PVS <br /> Type of Business: V L 1_ 5efli( LIZ/ e.ST A U r N-f <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 'Z- Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: cZ Applicant First Name: lAaqay <br /> Applicant Mailing Address: r -� <br /> city ( State ZIP Applicant Phone No: U '-3Z---7q3 -7Z- <br /> Water <br /> z Z <br /> Water Supply: +Public ❑ On-site Well Sewage Disposal: X Public ❑ Septic System <br /> Will there be any sale of firearms? Cl Yes ANo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above information is tr and correct Date: <br /> Applicant's Signature: 'j _/ 6 -b <br /> STAFF USE ONLY <br /> G/P Designation: G Zoning: C Use Type: lµry..✓b ti57at/jCrSHr+-E..!! - t-� SL/t cilc� <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: PG L -01(0 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Farms\Business License(Revised 10-20-05) Page 3 of 8 <br />