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APPLICATION — BUSINESS LICENSE <br />SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. & — 1 �0 C9 Z Sy <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: fL);s S4.cm S <br />Business Address: YOXS v Ld;l s"u Cross St AAi tIVIN <br />DBA Mailing Address: 74Q U ; c ur L City: , f ..41 o 0-3 State: C4 ZIP: T-SJO 7 <br />Phone #: 007- na,- 7.SG.3 Assessor Parcel Number(s): I L Z O ' O ci <br />Email: LrffPAR-rs CO, CZ 1-mrL <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: `Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: v t <br />Applicant First Name: J <br />Applicant Mailing Address: 67 3 U,, S L- <br />W", <br />City S"tC� cto,,k, State mZIP <br />Applicant Phone No: <br />Water Supply:Public ❑ On-site Well <br />Sewage Disposal: ❑ Public Xseptic System <br />Will there be any sale of firearms? ❑ Yes J4No <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 <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 />Applicant's Signature - <br />Date: is � 7 <br />/ <br />STAFF USE ONLY <br />G/P Designation: C Zoning: Use Type: Aifo,vvi .e- - Oe- it 5CtL,-,e_ <br />DEPARTMENT APPROVED DENIED DATE, <br />Development Services Planner Name: ! <br />Building Inspection <br />Environmental Health Div L ✓ r- s' 2 /S /7 <br />Fire Warder>I <br />Public Works <br />M.H.C.S.D. <br />License Approved For. y.e j , ` Q 1, e�ti�. <br />Remarks: �) - fts- - Or-) Lli <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForms&Handouts/PlanningApplicationsBusiness License (Revised 02-2415) <br />Page 3 of 6 <br />