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Px. APPLICATICIA BUSINESS LICENSE <br /> SAN JOAQUNy1�.(F(y(�(LIN�y\y�(y�(}�{���\MUNITY DEVELOPMENT DEPARTMENT <br /> RECEIV �Ld <br /> r_^ BUSINE LICENSE NO. 13L-07&6 <br /> Q�/FORS <br /> TO BE COMPLETED BY THE APkiEWIMEIT"LING THE APPLICATION <br /> Business Information <br /> Business Name: t SU r L-Ube- <br /> BusinessAddress: Z551oo )`I Hwj 99 Cross St aoII1eV RDn r�f� <br /> DBA Mailing Address: City: ACAMPO I State: ZIP: <br /> Phone#:(2L6 33-I--Loo Lo Assessor Parcel Number(s): _ -3 <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: "— <br /> Type of Business: 1 M -4— C <br /> Type of Organization: 8[ Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 3 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: I)CAnoke, Applicant First Name: <br /> I <br /> Applicant Mailing Address: -2-bl . H\N 11 <br /> City ACAMOD State (% I ZIP Applicant Phone No 2_M)32,-„3 <br /> Water Supply: ❑Public 6 On-site Well _ Sewage Disposal: ❑ Public Iq Septic System <br /> Will there be any sale of firearms? ❑ Yes P No <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 Signatur („rL-_ � <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: C R Use Type:/14, ato ZJQ r U - <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services ✓� Planner Name: / , Z <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: Af, I,/- —L CIZJ Ct1At�" S P f <br /> Remrks: rpf 4 0 ,p <br /> Occ. Grp. <br /> Accepted as Complete: Dale <br /> F:OevSvOPlanning Application FormsTusiness License(Revised 09-12-07) Page 2 of 7 <br />