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APPLICATION - BUSINESS LICENSE SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT BUSINESS LICENSE NO. Z 00 TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name:bLr_9v u a, Business Address: 112,51 rQ. UA..L Cross St DBA Mailing Address: �c �!� City: rWW'�N f State:e ZIP:47513'C Phone #: 86 _ 3 77 Assessor Parcel umber(s): Email: crggllw�f G �j Other Businesses at this Address: 4 Previous Business at Address: rW- ( A T_a&L Description of Business Operation:: �� y+(e /VLu"S MAY 2 12012 HEgj,7}(�EP A Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑Other: Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Applicant Last Name: F I E Applicant First Name: Le -e, Applicant Mailing Address: 7PO 6&1� 1559 City State- I ZIP"V:7:(Applicant Phone No: 50Q$Z Water Supply: ❑Public B On-site Well Sewage Disposal: ❑ Public p4eptic System Will there be any sale of firearms? ❑ Yes L?ko NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I, affirm, under penalty of perjury that all the above information is true and correct I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officersand a ees from any claim, �orr proceeding against the County arising from the Ow m�action /Age ro'ect. �""`%j Applicant's Signature: Date: 712, STAFF USE ONLY G/P Designation: =e— Zoning: Ci - 4J V Use Type: IL/;q.-�70 eS �•�� DEPARTMENT APPROVEP DENIED AT Development Services Planner Name: Building Inspection Environmental Health Div Fire Warden Public Works M. H.C.S.D. License Approved For: {S 4• G. tti Remarks: Occ. Grp. Accepted as Complete: Date: F:0evSvcW1anning Application FonnMBusiness License (Revised 7-14-11) Page 2 of 8 C