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APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />APR 0 2 2013 BUSINESS LICENSE NO.9;21,11,M111— <br />TOBEC6 07D 17FTHE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: r <br />Business Address: otO6,01 jiCross Sl <br />DBA Mailing Address: U (jI F7.i City: Lya/ State: (2%- ZIP: ,5-.24fv <br />j — / g0 — Q;,. <br />Phone #: �7'— ,3 rf Assessor Parcel Number(s): 050 <br />Email: IrIne UQ d +Uj <br />Other Businesses at this Address: <br />Previous Business or Address: <br />Description of Business Operation:: LvHOLEBF}LE /✓U,Q <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br />Estimated Number of Full Time Employees: /8o <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: 114619,4771,11,4'r -Applicant <br />First Name: 4419611 <br />Applicant Mailing Address: 1-047,91 61 <br />City /—Q/) / <br />Stale ZIP 6X Q <br />Applicant Phone No: Oq %Z7--,3 l <br />Water Supply: ❑Public >rOn-slte Well <br />Sewage Disposal: ❑ Public Septic System <br />Will there be any sale of firearms? ❑ Yes K 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 Dale: <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/Agent's project. <br />3�.?7 /� <br />Applicant's Signature: L <br />STAFF USE ONLY <br />GIP Designation: Zoning: Prti Use Type UV )/) —to <br />DEPARTMENT APPR ED DENIED DATE <br />Development 8arv1c=Planner Name• I 1 <br />Building Inspection <br />Environmental Health Div <br />Fire Warden o <br />Public Works <br />M.H.C.S.D. <br />License Approved For: NT -% <br />Remarks: <br />Oco. Grp. <br />Accepted as Complete: Date: <br />F/ApplicalbnsFonns&Handouts/PlanningApplications/Business License (Revised 11-14-11) <br />Page 2 of 6 <br />