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N <br />FIECEIVEDAPPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />SE -f' 0 a} G,vt:J, <br />BUSINESS LICENSE NO.—"e <br />STAFF USE ONLY <br />GIP Deslgnatlon: <br />TO BE COM L THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Use Type: <br />Business Information <br />Business Name: ..- <br />r <br />s <br />Business Address: 2 Cross St <br />/ H <br />DBA Mailing Address: City; 6 7FK State: ZIP: <br />Phone #:— y <br />.r 7 - I Assessor Parcel Numb l -- D " Al <br />Email; <br />Other Businesses at this Address: <br />Previous Business at Address: N <br />Description of Business Operation:: <br />Type of Organization: ❑ Single Owner ❑ Partnership C� Corporation ❑ Other: <br />Estimated Number of Full Time Employees: 3 Estimated Number of Part Time or Seasonal Employees. .,p- <br />,gApplicant <br />ApplicantLast Name: IJ S ZA G <br />Applicant First Name: a_ WWI v <br />Applicant Mailing Address: ,�—� l 6, <br />City 1 State ZIP r <br />Applicant Phone No:�i�- 711 - API 0 <br />Water Supply: 'Public El on-site Welly zpy <br />Sewage Disposal: Public [J Septic System <br />Will there be any sale of firearms? ❑ Yes V] 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 <br />%nerlAgent <br />Date: <br />I, the agree, to defend, indemnify, and hold harmless the County and Its <br />M.H.C.S.D. <br />agents, officers and employees from any claim, action or proceeding against the County <br />ansing_from the Owner/Agent's project. <br />Applicant's Signature: <br />STAFF USE ONLY <br />GIP Deslgnatlon: <br />Zoning: <br />Use Type: <br />lnAAi% r_c <br />DEPARTMENT APPROVED DENIED <br />Development Services <br />Planner Name: <br />01 3/16 <br />Building Inspection <br />f <br />J <br />Environmental Health Div <br />Flre We <br />" <br />Public Works <br />M.H.C.S.D. <br />F/ApplicationsForms&Handouts/PlanningApplicatlons/Business License (Revised 02-24.16) <br />Page 2 of 6 <br />