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Cloy. APPLICATIO BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> p) / <br /> BUSINESS LICENSE NO. IJL �� Z W11 t' <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: T-D ec 111 n p <br /> Business Address: 2$'03 50u. lt'A 99 CrossppSt n')Qr'1 0so— 'It I5 QJ <br /> DBA Mailing Address: IlLAg5 �AgOrr,. &Vd, City: r�QY\ aV f,L State: CA I ZIP: Q5742 <br /> Phone#: `• © Assessor Parcel Number(s): i1 q lit) -I <br /> Email: i £ A ACa. C.O <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: 1 201 <br /> ENVInn <br /> Lm DEPAR UrmliW <br /> AL <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: --p - <br /> Applicant Last Name: �' hn Applicant First Name: Y-' <br /> Applicant Mailing Address: A yq 1' �,spyy� V r [ZVO- y 2 <br /> City12QY-1C )D C.Dyi& ate a 1 Zipcolgz,I Applicant Phone No 9 j lo— (935-(�lo(v <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY R QUIRE 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,indemnify,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/Agen ' ct. _ <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation:j �. Zoning: 1' Use Type: /eco A <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden 'e <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> C 0 s e Ke <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />