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APPLICATION — BUSINESS LICENSE <br /> ,o.• ".�o <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '• BUSINESS LICENSE NO. <br /> �<<FORa <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name:_ C J S� <br /> Business Address:— 2--40 �AklISW Cross St <br /> DBA Mailing Address: City: 1 OCl State: ,1 ZIP: <br /> Phone#: ;0 c�. Assessor Parcel Number(s): — <br /> Email: <br /> Other Businesses at this Address: k/ ` <br /> Previous Business at Address: N <br /> Description of Business Operation:: <br /> Type of Organization: f6 Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: l t (J Applicant First Name: j j `) f�cy <br /> Applicant Mailing Address: ` C7 / <br /> City State ZIP 5;75 ' IC, Applicant Phone No:Q09)0 <br /> Water Supply: fkfPublic ❑ On-site Well Sewage Disposal: ® Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 10 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 Own7� kkULCA- <br /> / nt's project. <br /> Applicant's Signature: AM-L, <br /> STAFF US9 ONLY <br /> G/P Designation: C Zoning: �, Use Type: PAAQ 'S&Azo f v,-y '-&t-,N n°P u/3 t..-J— <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: p <br /> Building Inspection <br /> Environmental Health Div O <br /> Fire Warden,- <br /> Public <br /> arde Public Works <br /> M.H.C.S.D. <br /> License Approved For: 11 D J2 Lv f L6 01 <br /> Remarks: �[ <br /> _a g 7 bL -0t4- <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F.\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />