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poorT <br /> (" z <br /> u��•� APPLICATION BUSINESS LICENSE <br /> SAY 0 2 2008 2 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ENVIRONMENT HEALTH BUSINESS LICENSE NO. ofj�I�3 <br /> ;— DERNIVT�SFWGFS <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information r " <br /> Business Name: US r <br /> Business Address: 3 Cross Sltt"R T5 <br /> DBA Mailing Address: ' 33 City: � State: C ZIP($. o <br /> Phone#: (a0 _ so Q Assessor Parcel Number(s): - — I'- <br /> Email: 11 .1 C.tJ LJO cf W i_J- 4'L <br /> Other Businesses at this Address: <br /> Previous Business at Address: 660/71 <br /> Type of Business: <br /> Type of Organization: . ❑ Single Owner ❑ Partnership 01corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> oy7 <br /> Applicant Last Name: ' r tbp Applicant First Name: <br /> Applicant Mailing Address: ^3. L- rh lS kt• ,�•{-pL C-+- <br /> City S-d Cj State Cj9— ZIP 9 Applicant Phone No: g —9036 <br /> Water Supply: ❑Public On-site Well Sewage Disposal:16Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY RE UIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above information is tru correct Date: <br /> Applicant's Signature: U — 16 <br /> G/P Designation Zoning: 1 ^ Use Type: -a�_.- �S <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div a <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: U�y� <br /> Remarks: Q� <br /> S vo <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 01-16-08) Page 2 of 8 <br />