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SAN 5OAQUIN COUNTY control No. <br /> BUSINESS LICENSE APPLICATION Bate L B. L. No.o. Issued <br /> M-.. / <br /> �Iteceipt No. l <br /> Fee 1 Yr.[:] 3 Yr,.� <br /> (Please print or type) <br /> 1. Business Name >Purefto owqxnY Phone(20)466-2041 <br /> i <br /> 2. Business Address MW StrYAcerai- (3k- 95206 <br /> (addii (city) (zip code) <br /> 3. Mailing Address PA TICK WM Stockbm elk. � <br /> rP. (addiii y�.����� �y.������.. (city) (zip code) <br /> � Chad ca1sr Feet i�I <br /> 4. Description of Business <br /> 5. Type of Organization: ❑ single owner, [I]partnership, Pgcorporation <br /> 6. Estimate Number of Employees: 20 full time 15 part time or seasonal <br /> 7. Owner(s) Name » cafwgy Home Address1276 halyard t r. Phone (91072-7011 <br /> West sea=aeeat!co, ca. 95491 <br /> 8. Manager's Name (if corporation) R-C- Mmrcgr Phone(209)466"'2"1 <br /> 9. Previous Owner's Name sam am ebaye <br /> 10. Other Local Business'`Addresses tJ= Blvd. i Peecaderor Tracy, Cin. 95376 <br /> t 11. Is there another business at this location? no <br /> I hereby certify under penalty of perjury that the above information is true and correct to the best of my knowledge and <br /> belief. <br /> ff <br /> (Applicant's Siy'pature) > , r, tilt. <br /> (Date) (Phone)- - - <br /> Applicant shall secure all necessary permits within 30 days upon receipt of letter of corrections from <br /> any applicable department. <br /> FOR COUNTY USE ONLY <br /> COPIES DEPARTMENT' BY D TE REMARKS <br /> (White) Planning Division 1%fiz <br /> I (Blue) Building Division <br /> (Green) Fire Warden <br /> (Goldenrod) Public Works 1%1 _ <br /> (Pink) Local Health District <br /> (Canary) Applicant Approved Date <br /> Assess o 'sf �r !7 — Zone /� <br /> Proper ss j/ s <br /> (Street Name) <br /> Hf 3Ai4! iATaiwtltl►YN (city) (zip code) <br /> 2 ry <br /> NOTE. )� a�ions shall become void within 180 days of implication if all necessary approvals - <br /> have not been secured. <br /> ®PLANNING 21 (10/83) �"" "1 • <br />