Laserfiche WebLink
APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 14 2018 <br /> ENVIRONMENTAL BUSINESS LICENSE NO. rX—� i 0 Iy i <br /> PERP�!1Ti AL,HEALTH <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> An Business Information <br /> Business Name: 0 (- OIC <br /> Business Address 2(+�c�U LA-1a4,r 1c), C v Cross St :y <br /> DBA Mailing Address: I�} �n-�e—,T(z - City: �t- State:(,./ ZIP Z�'S <br /> Phone#: 'L U�� y�� — c;,I��3 ti Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: 411111 <br /> Previous Business at Address: <br /> Description of Business Operation:: r ed Ile �, y C It 1.5 <br /> Type of Organization: ❑ Single Owner ❑ Partnership �&Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: (p rrr�� Applicant First Name: f V1 (}, CC b <br /> Applicant Mailing Address: � ci wo'k,,r (_0 C, <br /> City � (' 1-.i,., State ( -, zIPrY U U r--, Applicant Phone No: z -Y Q 'L <br /> Water Supply: 4rpublic ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 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 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 � _ ('Z <br /> arising from the Owner/Agent's project <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: - Zoning L— V Use Type: �.� `o,le <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: tp, �F (")0j7-- <br /> Building <br /> ,?-Building Inspection <br /> Environmental Health Div <br /> iFire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. �� t S ' F r �� M f l,. >✓ S � :i(i iJ <br /> Remarks: `_ ?C)Z�� <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/Applications Form s&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 3 of 5 <br />