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ageyl" APP BUSINESS LICENSE <br /> •.a <br /> e ? SAN JOAQUIN COUNTY EDLOPMENT DEPARTMENT <br /> N: [ <br /> BUSINEff-SCE <br /> o C7koA�vp• bm JU <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 12 <br /> Business Address: Cross St <br /> DBA Mailing Address: 'Z City: " Stateca T ZIP:Q$Z <br /> Phone A: — ) s Assessor Parcel <br /> B -T- <br /> Number(s): Zp- 2K0 _ t7z � <br /> Email: V <br /> Other Businesses at this Address: <br /> Previous Business at Address: IJ ry <br /> Type of Business: <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: ' ir Applicant First Name: <br /> Applicant Mailing Address: T Z) <br /> City L. State tom- ZIP 9 S Z Applicant Phone No: D 3 3 V/— Of 7$— <br /> Water Supply: 420ublic ❑ On-site Well Sewage Disposal: ®'Public <br /> ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes WFo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: (�K <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services .� Planner Name: <br /> Building Inspection 1, <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: 1✓ <br /> Remarks: ��� I��- - '1.=;' <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:0evSvcNPlannin9 Application Forms\Business License(Revised 12-24-07) Page 2 of 8 <br />