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-:5"/)(9 /C;)0`9 <br />APPLICATION -BUSINESS LICENSE <br />>.• •.o <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />r <br />BUSINESS LICENSE NO.N-y I (3 1) el <br />•QC i::::eC� <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: Smcx <br />Business Address: 71420 L,J(t4.,, ttW Qp,4A. <br />Cross St j <br />DBA Mailing Address: ���� -. Z Com. <br />City: , <br />State: ZIPq!� —Zl" <br />Phone #: _-� y- l Z <br />Assessor Parcel Number(s): <br />Email <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: .. S -'r bh\ r-� fi C-) , <br />Type of Organization: ETSingle Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: �y� <br />Applicant First Name: <br />Applicant Mailing Address: 2-T <br />City <br />State(�)q <br />Applicant Phone No: <br />Water Supply: Public ❑ On-site Well <br />Sewage Disposal: 9KP,blic ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes ©To <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all th mation is true and correct <br />I, the Owner/Agent agree, to , indemnify, and hold ha less the County and its <br />agents, officers and oyees from any claim, action or pro' eeding against the County <br />arising from the ner/Agent's project. <br />Applicant's Sign ure: <br />Date: <br />STAFF USE ONLY <br />G/P Designation: C1 Zoning: L Use Type: ALM r�,�� f' f C a &--oak "' <br />DEPARTMENT APPROVED <br />DENIED <br />DATE <br />Development Services <br />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: e-�x-j rA G 5, ` K "�j L <br />Remarks: <br />/-� -7 <br />r .S ( � KPC f ll — f -i �7 Y5L V L C_' 3C c'S <br />rJL'C -72 - `} -'j 2� t Z <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 3 of 6 <br />4 <br />