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APPLICATION - USINESS LICENSE <br /> �t <br /> SAN JOAQUIPj COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. GI O U 2-33 <br /> C4Ci F O PtN�P <br /> E14 <br /> _ TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICAI D <br /> Business Information i = 5 LJi <br /> Business Name: L S d-Fan MA RT <br /> P/ <br /> Business Address: 1qM0S ST Ri' 9 y Cross St L OFFICE OF EMERGENCY RVICES <br /> DBA Mailing Address: SAMf City: N 1� State: ZIP: q$ <br /> Phone#: IC39 - I Assessor Parcel Number(s): -+ - <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: 5-rM wrii, 6 <br /> Type of Organization: ❑ Single Owner M Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: -5- Estimated Number of Part Time or Seasonal Employees: {� <br /> Applicant Last Name: P,rAbo a- Applicant First Name: t„ <br /> Applicant Mailing Address: I M 6�16mD <br /> �Li N, rr <br /> City pt N,TXCStateC ZIP JO6 Applicant Phone No 01 c I)- b3 <br /> Water Supply: ❑Public On-site Well Sewage Disposal: b Public 54 Septic System <br /> Will there be any sale of firearms? ❑ Yes 0 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, indemnity, 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. ( 8_ <br /> Applicant's Signature: ./ � <br /> STAFF USE ONLY <br /> G/P Designation: S- Zoning: <br /> DEPARTME APPROVED DENIED DATE <br /> Development Services 2/ Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: y <br /> Remarks: ll <br /> — <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 7-14-11) Page 2 of 8 <br />