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Ahk G5 �, -Ili I�s APPLICATION 'BUSINESS LICENSE SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT w t BUSINESS LICENSE NO., ',VIJJ� TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLI Id Business Information MAY 2 7 2010 Business Name: 00 (1171y RRAO N9 /NP NG Business Address: 2 3,yg 7 Cross St H RD. OFFIOE OF RAERGENCY DBA Mailing Address: City: AGAM State: C4, ZIP: 3Zzp Phone#: 'Z09 6.G—/D Assessor Parcel Number(s): Email: Other Businesses at this Address: Lobt Alepo&T Previous Business at Address: (J J6.,J Description of Business Operation::.L- AU1,4-ric>wJ Type of Organization: % Single Owner ❑ Partnership ❑ Corporation ❑ Other: Estimated Number of Full Time Employees: Z Estimated Number of Part Time or Seasonal Employees: O Applicant Last Name: Applicant First Name: k Applicant Mailing Address: qY7 M. H? / WA City State CA. I ZIP Applicant Phone No: 201 36 - o40 Water Supply: ❑Public ;9 On-site Well Sewage Disposal: ❑ Public CK Septic System Will there be any sale of firearms? E] Yes JA No 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 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. Applicant's Signature: �c-- Date: STAFF USE ONLY GIP Designation: Zoning: - Use Type: DEPARTMENT APPROVED DENIED DATE Development Services Planner Name: Building Inspection Environmental Health Div Fire Warden Public Works M.H.C.S.D. License Approved For: V :'- Remarks: O , Dec. Grp. Accepted as Complete: Date: F:\DevSvclPlanning Application Forms\Business License (Revised 01-25-10) Page 2 of 7