Laserfiche WebLink
0 on <br /> —�'•a APPLICATION — BUSINESS LICENSE <br /> JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �i�',5,� °NVIRONM�NTAI MII:M BUSINESS LICENSE NO. A - I�/ ' �) <br /> j:RVICES� <br /> --- TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> /� Business Information <br /> EPhanet. <br /> : C� - ` <br /> Is3'L,1,' Cross St <br /> w- CitYt I UG>Lt,. Slate: eA J zIP: q-,-2 <br /> __ Assessor Parcel Numbar(s); O(j r� ., ( 0— —000 <br /> Email: It e. <br /> Other Businesses at this Address: —`—""--- <br /> Previous Business at Address: <br /> Description_of Business Operation;: �•� 5 (. S r <br /> Type of Organization: f] Single Owner — G Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Pail Time or Seasonal Employees: } <br /> Applicanf Lust Name: �G tLr, •__.__�_ Applicant First Name <br /> Applicant Mailing Address: C � <br /> Cay 0- %AL/Lb state P- ZIP S 4 7.1 Applicant Phone No: ( CI((L 5�i^ d i <br /> Water Supply; (]Public (] On-Aite Well Sevtago Disposal^0 Public 0 $spite System <br /> Wdl there be any sale of firearms? 0 Yes X 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 <br /> agents, officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature; V��'1kY+It.-� I a—rl , l- <br /> STAFF USE ONLY <br /> G/P Designation: C S 2oning; C— FS Use Type: 6aS n <br /> -- o S rs -- Cpm / <br /> Ll <br /> DEPART44ENT APPROVED DENIED DA <br /> IZ <br /> Development Services planner Name: zzr <br /> Building Inspection <br /> Environmental Health ON C U (U <br /> Fire Warden Wood�/iILL <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> 0100 0 -2 .Z- --gaOco,Grp. <br /> Accepted as Complete: Data: <br /> FlApplkationsForms&HandouisrPlanningApplicalionsfBusiness License(Revised 11-14,11) <br /> Page 2 of 0 <br />