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°PnU'M O RECEIVED APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> j { ,,. FEB 0 2 2016 BUSINESS LICENSE NO. �5L- "16 Vu U Jy <br /> ENVIRONMENTAL HE"TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: V A oJD <br /> Business Address: LA Ur L 1 L Cross St I le-0 <br /> DBA Mailing Address: (l jl y 7 `)1LC� ;��(°�1l City: 'C State: CA ZIP: 9. L f <br /> Phone#: Z.C°( 9 _q Assessor Parcel Number(s): (� S <br /> Email: {V �Cf� knO• cc <br /> Other Businesses at this Address.' <br /> Previous Business at Address: <br /> Description of Business Operation:: it tr 'j4tp res <br /> A <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: L Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 14,n Applicant First Name: Pw r <br /> Applicant Mailing Address: 2_-qC,6 Wil, yl <br /> City j' L State &AZIP C 5Z( Applicant-Phone No: ao" <br /> Water Supply: © ublic ❑ 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 <br /> arising from the Owner/Agent"9 project. l' <br /> Applicant's Signature: — <br /> STAFF USE ONLY <br /> GIP Designation: L f_ Zoning: y �� Use Type: A�� ,1 G rr ,�S p,I,/ <br /> 1 <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div �t9t0_777 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> HOcc.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplicabons/Business License(Revised 02-2415) <br /> Page 2 of 6 <br />