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® L10 -fart <br /> °Iti.,'•A� We APPLICATION 4X3USINESS LICENSE <br /> T <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> zi 1 v `1QQ�� <br /> � BUSINESS LICENSE NO.�, • t�)�AJ�IX�'• <br /> IFOa <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: u-STR\ ,T . lac-- <br /> BusinessAddress:3I SS.HW199W.fR0a7aa,E•av• Cross St (MIU 'FoRL7 AQe. <br /> DBA Mailing Address:3tlS 5. NW4g9w•FKctyraG6'Ro. City: i1ceKroa State:CA ZIP: g5Z\5 <br /> Phone#: Zp9-6114$-S Z45 Assessor Parcel Number(s): <br /> a <br /> -,A '} h rr1 <br /> usinesses at this Address: <br /> Business at Address: 'DEc..TA ScRAp E•rAc- 'P'i.0 E.35o 5 <br /> onofBusinessOperation:: (,tS£A YAstCS SAt,.Es Au-ta t5 AaT�•Iwl4 <br /> Organization: ❑ Single Owner ❑ Partnership IN Corporation . ❑ Other: <br /> d Number of Full Time Employees: (o Estimated Number of Part Time or Seasonal Employees:t Last Name: ATC CT Applicant First Name: ScpTTt Mailing Address: $25g •Pt_Um6.41A AJE. <br /> IR oArS State . ZIP�j5G28 Applicant Phone No: atl&-y)'. RogO <br /> Water Supply: ❑Public ® On-site Well Sewage Disposal: ❑ Public ® Septic System <br /> Will there be any sale of firearms? ❑ Yes Z 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,indemnify,and hold harmless the County and its <br /> agents,officers a employees from any claim,action or proceeding against the County <br /> arising from the nerlAgenY pro€�t. <br /> Applicant's Signature <br /> STAFF USE ONLY <br /> lco <br /> G/P Designation: ` Zoning: ` -tr• Use Type: '� S- I� <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services 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: <br /> Remarks: �y <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSwTianning Appliwlion Forms\Business License(Revised 01.2510) Page 2 of 7 <br />