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CPQ' <br /> ui, - .i. MEAL!h <br /> pP4�'' c( S?1fICF APPLICATION — BUSINESS LICENSE <br /> ,oma <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � Iam 5 I5 <br /> '• I� BUSINESS LICENSE NO. <br /> rFORN <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: t r <br /> Business Address: Ip Cross St (, <br /> Mailing Address: City: '+ Slate: CA ZI _ <br /> Phone#: G_ — Assessor Parcel N mber(s): �[�--. -- <br /> Other Businesses at this Address: t? . j <br /> Previous Business at Address: _ '~ <br /> Type of Business: <-�� kAf <br /> F <br /> pSalksp <br /> Type of,organization: R Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Tim r Seasonal Employees: 0 <br /> Applicant Last Name: it C,(r F'.S Applicant First Name: <br /> Applicant Address: 1 I <br /> City 12 State , ZIP /g S Applicant Phone No: <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE CC ANC REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> Applicant's Signature: 144 Date: . I102 <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: jL <br /> DEPARTMENT APPROVED DENIED .DATE <br /> Development Services v Planner Name: a <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Erdorcmnent Officer <br /> License Approved For: y vp hr K a / Kca <br /> (eJ E�..S �e55e5 <br /> Remarks: <br /> Accepted as Complete: Date: <br /> F:tDevSvclPlanning Application Forrns%Business License(Revised 12-3"2) Page 3 of 8 <br />