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APPLI - SINESS LICENSE <br /> i SAN JOAQUIN COUNTY CC f^UNIT,! NELOPMENT DEPARTMENT <br /> BUS1we ' r �--x- <br /> C/FORS <br /> TO BE COMPLETEDBY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business/Information <br /> Business Name: 'PR6 q44 07/7/an LLC- nCIG <br /> C0 , // <br /> Business Address: /Mlo - Hg g 104" Cross St f' #p[�j <br /> DBA Mailing Address: 474P9 q S City: falrflad State: 61 zIP94,f / <br /> Phone #: tO - $7-S : VA,- po -t9 Assessor Parcel Number(s): Q,j-�� ?Jj_ -000 <br /> Email hermledIA wo G [L , — nL <br /> Other Businesses at this Add ss: k� - ( 7 H I r /L 6 /0/(L <br /> Previous Business at Address: �/ A <br /> Type of Business: A4 A it p <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation , iA Other: L L <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: Afa <br /> Applicant Mailing Address (� 94(59-- 4117r <br /> City Pq IP it:/d State ZIP 9 Ap icant Phone No: 7Q - a d T edr <br /> Water Supply: 9Public ❑ On-site Well Sewage Disposal: Rr Public ❑ Septic System <br /> Will there 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 abov n is true and correct <br /> Applicant's Signature: � ', JD/✓- / <br /> STAFF USE ONLY <br /> G/P Designation: C-C, Zoning. GlC, Use Type: I✓-a <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.KC-S.D. <br /> License Approved For. <br /> Remarks <br /> Occ.Grp. <br /> Accepted as Complete Date: <br /> F'.TevSvc\Planning Applicabon FormstBusine55 License(Revised 08-21-07) Page 2 of 7 <br />