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J . <br /> �la--W�ao/8 <br /> O APPLICATION - BUSINESS LICENSE <br /> 4 2018SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ENVIRONt,�EN7g1 BUSINESS LICENSE NO. >(_—I �)�'d >'y <br /> �•. P, HEALTH <br /> PERMIT/ it <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: i I, C f� <br /> Business Address: 2L4-40 ' (1,1ar 1Uc; e l�) Cross St <br /> DBA Mailing Address: I we-p-r�6 D P0 City: State:(-4 ZIPq <br /> Phone Sk: 'L v ci -1 17)1 - L 1� 13 I`� Assessor Parcel Number(s): <br /> Email: ,`' U r- uk� d v 1 J S o) cc,,vv( <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: r ec <br /> Type of Organization: ❑ Single Owner ❑ Partnership [ .Corporation ❑ Other. <br /> Estimated Number of Full Time Employees:i;� Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: V) <br /> Applicant Mailing Address: � J Uv Q <br /> City � ri Lai,., State ZI Sj U S Applicant Phone No: 2 -L(Q 'G' <br /> Water Supply: Public ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> r <br /> ill there be any sale of firearms? E] Yes No <br /> OTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> affirm,under penalty of perjury that all the above information Is true and correct Date: <br /> 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 6 <br /> arising from the Owner/Agent's project <br /> Applicant's Signature: 9S2�� 1 <br /> STAFF USE ONLY <br /> G/P Designation: 11j Zoning: L- U Use Type: '(p -Ix�(e> d J <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div - SU Q I JZ <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. �j`.' L S r ��} "M ;< ILS ��(!Lt L)'-�> <br /> Remarks: <br /> om Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 3 of 5 <br />