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r - 4-n <br /> APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 3�1 <br /> BUSINESS LICENSE NO. <br /> 2010 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION' n COUNTY <br /> Business information NCY SERVICES <br /> Business Name: , <br /> Cross St <br /> Business Address: <br /> City: StateC ZIP: <br /> DBA Mailing Address: <br /> Assessor Parcel — <br /> Phone#: <br /> Email: <br /> Other Businesses at this Add <br /> Previous Business at Address: <br /> Description of Business Operation- <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation roar: <br /> Estimated Number of Full Time Employees: Estimated Number of Pan Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: , <br /> Applicant Mailing Address: <br /> City State Zlf�� \ Applicant Phone No: — <br /> Water Supply: []Public n-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes o <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 /> a the Owner/Agentagree,to defend, indemnify, and hold harmless the County and its <br /> agents,officerscersan and employees from any claim, action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: / l.N• Z. <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: 1ene IYI <br /> DATE <br /> DEPARTMENT APPROVED DENIED - <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: <br /> 1 V <br /> Occ.Grp. <br /> Date: <br /> Accepted as Complete: <br /> Pa e2of7 <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) g <br />