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RECOIVED -��- <br /> �p4ulN C JUL 31 NAPPLICATION - BUSINESS LICENSE <br /> w. <br /> 2:���pp�� •�y JOAQUIN COUNTY COMMUNITY DEVELOPMENT pEPARTMENT <br /> ENVIRONMENTAL BUSINESS LICENSE NO. <br /> HEALTH DEPARTMENT <br /> Fp R� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION'" <br /> Business Information <br /> Business Name: <br /> t-(" OLui <br /> Business Address: 1�0) Cross St <br /> DBA Mailing Address: ( City: Slate ZIP.q 5 <br /> Phone#: 1 Assessor Parcel Number(s): / <br /> Email: i l. <br /> Other Businesses at this Address. <br /> Previous Business at Address: 1 _ - <br /> J' X12 i ' <br /> Description of Business Operation:: � �` <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 /> 01 <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address: �"f5 S, <br /> City VU� S l State ZIF� Applicant Phone No: <br /> Water Supply: ublic On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes I(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 and employees from any claim,action or proceeding against the County a� j <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: _ <br /> L STAFF USE ONLY <br /> G/P Designation: 1z Zonin / Use Type: b 2 L7 ) <br /> DEPARTMENT AP OVED DENIED ATE <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: q <br /> Remarks: 111N N' p i, ILG I rn <br /> te. <br /> Occ, rip. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 7-14-11) Page 2 of 8 <br />