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APPLICATION — BUSINESS LICENSE <br /> : SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: to Lv17. o,*- � pVy�V/me- <br /> Business Address: 2(O(o.- AJ 0j'N 1 SarCross St � � t A 1 0- vu , <br /> DBA Mailing Address 2('A0' N W i Koel J City S ( Slate zip.-Is <br /> Phone#. ��- g- Assessor Parcel Number(s). <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address. <br /> Description of Business Operation.: Yv.v R cc v y _0_'Pe1�f <br /> Type of Organization: 1�9-Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: ',cK <br /> Applicant Mailing Address. 2_G(o Z /1. iN�k SOv1 A <br /> City UN.kl>y, State CW ZIP 9�2 o S Applican hone No: 2 (DC-1 <br /> Water Supply Public ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes tkNo <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 cl ,mon or procee ng gainst the County <br /> arising from the Owner/Agent's pro' t. <br /> Applicant's Signature. <br /> S AFF SE ONLY <br /> G/P Designation: C Zoning: - Use Type S <br /> DEPARTMENT A R VED DENIED DATIE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> L <br /> Fire Warden 6W <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For J ,/ r onYW L 0i WO* <br /> Remarks �QL . <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F 1DevSvclPlanning Application Forrns\Business License(Revised 7-14.11) Page 2 of 8 <br />