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" APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `r BUSINESS LICENSE NO. <br /> 7_J. H. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name. W111.5ksjou4h ina L L C <br /> Business Address: S. ,Cross St <br /> ffi'QhiA Ll <br /> DBA Mailing Address: S. S u + State: ZI P 3 <br /> Phone K' - - Assessor Parcel Number(s): l <br /> Email: r6 +c— O(Apro <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation.: L agai f v.f <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation ther: LL <br /> Estimated Number of Full Time Employees 3 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: CG e I—n(-t) Applicant First Name: <br /> Applicant Mailing Address 01 S. IaYtcl hblP, 64 '612,31 <br /> City � Slate (�/� ZIP pplicant Phone No: t (oC� <br /> Water Supply: ❑Public �On-site Well Sewage Disposal: [I Pubic ll!septic System <br /> Will there be any sale of firearms9 ❑ Yes UeNo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REOUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,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 /> Applrcanls50 I <br /> STAFF USE ONLY ` <br /> GrP Des gnallon Zoning 1_ - 1 J Use Type i �i F._ - t�Yvl V <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div 0 <br /> Fire Warden SU oou <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: <br /> Occ.Grp. <br /> AccepterJ as Complete: Date: <br /> F 0evS'a:Planrinq AoDiication F-,—8,-nn;; Pago 2 Off? <br /> X10T 4 t' o"too* <br /> �/ ar <br /> �o 0 <br /> I � 1 139U <br />