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f-----`---- -------- - ' 12,/(,Z26/ -�- APPLICATION — BUSINESS LICENSE CEwE� ' . SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT '•'-• EC U 5 2017 BUSINESS LICENSE NO.ll 41 P 126117 - TO BE COM0i:6tD BY THE APPLICANT PRIOR TO FILING THE APPLICATION n/ Business Information Business Name: 11� Business Address: �Cp (� p(, Cross St C vk DBA Mailing Address City: GState: ZIP: In sw U s Phone ar:zoo7 aql Assessor Parcel Number(s): z Email: Other Businesses at this Address: Previous Business at Address: ^ Description of Business Operation:: iJTDll Y' , 160 - Type Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. Estimated Number of Full Time Employees: a Estimated Number of Part Time or Seasonal Employees: Applicant Last Name: Applicant First Name:nr2� Applicant Mailing Address: Z(y ``tCal w ' Q�-, j A- ` -1 (/ CA cf5 City I State ZIP Applicant Phone No: Water Supply: tkublic ❑ On-site Well Sewage Disposal: Public ❑ Septic System Will there be any sale of firearms? ❑ Yes No NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I, affirm, under penalty of perjury at all the above Information Is true and correct Date: I, the Owner/Agent agree, to efen , Indemnify, and hold harmless the County and its 1911 7 agents, officers and employ s firm any clai action or proceeding against the County I arising from the Owner ge 's p oject. Applicant's Signature: STAFF USE ONLY GIP Designation: L Zoning: _ (� Use Type: AJO DEPARTMENT APPROVED DENIED DATE Development Services Planner Name: (� . 5 4 f', r Z I ZO / Building Inspection //`` Environmental Health Div — V U S E L Y) 7 Fire Warden Public Works M.H.C.S.D. ++ License Approved For.IP Remarks: L— ii ��; 2s 1 L -09 l.3 in Occ. Grp. Accepted as Complete: Date: F1ApplicationsFonnsBHandouts/PlanningApplicabonsBusiness License (Revised 02-24-15) Page 2 of 6