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51 /00� <br /> s PqU,IV. <br /> APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> + !' BUSINESS LICENSE NO. � <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: I�'ty►L�r+ Ind>ft� ffi •-f e Y al i ,rL . <br /> Business j �( 7 1,. (.7 D A pCross St ; r <br /> DBA Mailing Address:?o-9 p s X31 15ZI I City St&G'K+-0fJ State: L'� ZIP: q 5 Z)S– <br /> Phone#: 'L„r C;> L' qI Assessor Parcel Number(s): ? ' -f'� <br /> Email: Kknc ) 'n YLtA, f;r <br /> Other Businesses at this Address: tj <br /> Previous Business at Address: Grepthr n <br /> Description of Business Operation:: �� t( J S Ian Gilt j-p rJ rt Vnv II Lk 4-L - <br /> coraf=-NViR0NK4E1NTAL I TA_..a <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: 2- <br /> Applicant <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address: PO GZ a 3 1 J <br /> City SfiJ (.J1`t0"" State zipq52-0 Applicant Phone No: (ZO 41) L A—g <br /> Water Supply: LK ublic ❑ On-site Well Sewage Disposal: ublic ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes GKNo <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 <br /> arising from the Owner/AgZron, <br /> Applicant's Signature: d S/r:1'J/� <br /> STAFF USE ONLY <br /> G/P Designation: %� Zoning: �j Use Type: -, <br /> DEPARTMENT APPROVED DENIED , rDAT <br /> Development Services Planner Name: �/ t <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 /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 2 of 6 0 <br />