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a�ln APPLICATION — BUSIN <br /> P <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPAR-I�AENT <br /> BUSINESS LICENSE NO./ �`� > I 1 <br /> �rFOR� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: A y L Oa r V t f Alc_d AVTJ�A+�vvCr '1t B A MAA 6-J A V LTJ <br /> Business Address: ogy LJ,(s itJpn 1l/l- Cross St CiAcrtu KCG. 7-4?vic h < <br /> DBA Mailing Address: yy 7 W,Gwa,k 'Da- City: ST004TOAl State:eA- ZIP: S'SJ i!1 <br /> Phone k W-6cl6 -02Z Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: //1) <br /> Previous Business at Address: (f,J p:, 0,VAJ- <br /> Type of Business: p UT L) <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: /Q Estimated Number of Parl Time or Seasonal Employees: <br /> Applicant Last Name: Ro StW S/<I Applicant First Name: Lr p �•1 L ti trV C <br /> Applicant Mailing Address: � 17 1 G a/A/— 'fl(l- <br /> Chy 5-TJCKYO✓ State d- ZIP OS Applicant Phone No: � <br /> Water Supply: JPublic ❑ On-site Well Sewage Disposal: I$ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes V No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> ,stn <br /> Applicant's Signature: d , � /l �r� <br /> STAFF USE ONLY ✓fe <br /> GIP Designation: ,(„ L Zoning: Use Type: <br /> DEPARTMENT APPRO DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Heaft <br /> Fire Warden <br /> Public Works <br /> M.H.CS.D. rr <br /> License Approved For: <br /> Remarks: n [% b J �Q b <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F xDevsvoPlanning Applicalion Forms\Business License(Revised 09-21-07) Page 2 of 7 <br />