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APPLICATION — BUSINESS LICENSE <br /> T qu SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P: <br /> BUSINESS LICENSE NO.15 L - % OOI ) ii� <br /> • c< ,�vP <br /> /Fp <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address: — Cross St AAA rcA e.A2 <br /> DBA Mailing Address: 1-I I City: p State: ZIP. <br /> Phone#: QL 1 9Assessor Parcel Number(s): 2v 0 3 <br /> Email: ' L, t <br /> Other Businesses at this Address: <br /> Previous Business at-Address: All <br /> Description of Business Operation:: J E OF EMERGENCYS RVICES <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address: 9 <br /> City State ZI Applicant Phone No: -7 — <br /> WaterSupply: ❑Public -inn-site Well Sewage Disposal: ❑ Public —13".$eptic system <br /> Will there be any sale of firearms? ❑ Yes 7EkNo <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: 2-9-10 <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/ nt's project. <br /> Applicanrs Signature: <br /> USE ONLY <br /> FLDesignation: �r < Zoning: X -4 Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services r,/ Planner Name: d <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. ! <br /> License Approved For: �N t"Vt rn V�i/�.f,> V ry O JS InI <br /> p <br /> Remarks: 6 <br /> L – $'� - o � o Cion-' d5 yrD� <br /> Occ.Grp. <br /> Accepted as Complete: Dale: <br /> F:%DevSvclPlanning Application FonnslBusiness License(Revised 01-25-10) Page 2 of 7 <br />