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p4U " ITC01016WTION - BUSINESS LICENSE <br /> SAN JOAQUIN CO1JNTKJNITY DEVELOPMENT DEPARTMENT <br /> 0FHGEOF§MM*1—SE NO._D(p QU�S l <br /> C4[%F ORa`� <br /> WBusl <br /> BE COMPLETED BY TH4-APPLICANT PRIOR TO FILING THE APPLICATION <br /> ss Information <br /> e: �.5 'VCss: �1r7CCrossst <br /> dress City: µ n{ .Stater C P ZIP:.9s3 <br /> #02!Z) �or - g dr b Assessor Parcel Number(s): �I $ Ozp <br /> .I <br /> es at thisAddress: <br /> Previous Business at Address:—D d <br /> Typeof Business: A �/ -r <br /> Type of Organization: mingle Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: rk j Applicant First Nam <br /> Applicant Mailing Address: 61 S Cq !-e I <br /> City kAmA State ZIP Applicant Phone No: 0- 1 <br /> Water Supply: []Public B'-On-site Well Sewage Disposal: ❑ Public [9'-Septic System <br /> Will there be any sale of firearms? ❑ Yes ©'% <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> Applicant's Signature: C L� 3_ I o <br /> STAFF USE ONLY 1 <br /> GIP Designation: C G Zoning: C C1 Use Type: S lzuIC.� TtUG airs. 0A <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Na <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: LJYL��S L _ i73LR)3t�" <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSvc\Planning Application Fonns\Business License(Revised 10-20-05) Page 3 of 8 <br />