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Op4UI /J' , APPLICATION - BUSINESS LICENSE <br /> '% SAN JOAQUIN- COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE No . �0O I q <br /> s <br /> TO BE -COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: ` I urvinfA <br /> Business Address: JT <br /> 2, I � � ► I Cross St <br /> DBA Mailing Address: LlD tib ctM Oft � city: State: C« , <br /> Phone #: • Ocl • q1S& Assessor Parcel Number(s): <br /> Email : M6Ylivul Lur Z 1 <br /> Other Businesses at this Address: RECEIVED <br /> Previous Business at Address: <br /> AUG 14 2018 <br /> Description of Business Operation: : ( IV M ) r WE SE ( 4 d1 � EPf� l <br /> CHVMEN FAL HEALTH <br /> DEPARTMENZ <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees ; 1 - Estimated Number of Part Time or Seasonal Employees : <br /> Applicant Last Name: l u 11 Applicant First Name: Ni <br /> Applicant Mailing Address : 2 U 2 o N GIK <br /> City (, State CA ZIP C155)y, Applicant Phone No: ®N 444 <br /> Water Supply: 'gublic ❑ On-site Well - Sewage Disposal : ❑ Public Xzeptic System <br /> Will there be any sale of firearms? ❑ Yes 0 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/Age is project. J <br /> Applicant's Signature : / / 1y <br /> STAFF USE ONLY <br /> G/PDesignation : _ Zoning : Use Type: - (A it <br /> DEPARTMENT APPROVED DENIED DATE v <br /> Development Services Planner Name: Wnst)ALc� V <br /> Building Inspection- <br /> Environmental <br /> nspection Environmental Health Div oQ (� V <br /> Fire Warden <br /> Public Works <br /> M . H .C.S.D, <br /> License Approved For: ij L W AA A (A y ( e. <br /> c 01- - <br /> Remarks: <br /> 04 ' 000 .50 <br /> Occ. Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-2415) <br /> Page 3 of 6 <br />