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APPLICATION — BUSINESS LICENSE <br /> JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> x <br /> Py <br /> [ECQSNESSLICENSE NO. 01,0(F?0 <br /> L <br /> '1009 <br /> TO BE COM --�YjMPPLICANT PRIOR TO FILING THE APPLICATION <br /> E� <br /> Business Information <br /> Business Name: /AWTrzCA AV-PcaV--) <br /> Business Address: • AVE; Cross St kv/%/ q'5--530 <br /> DBA Mailing Address: 3737 P-'/05FM1Y IWC— City: 4. .(-I K o (2 State: ZIP: <br /> Phone#: a 0q Ta—1 � Assessor Parcel Number(s): ;�41 <br /> Email: <br /> I AL V10 U Q I Q n VA <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: 'Tav%-,- AA,-O 1Dtc--->7,4&A/y7-L-59s <br /> Type of Organization: 93-6fin—gle Owner El Partnership [I Corporation El Other: <br /> Estimated Number of Full Time Employees: =Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name:M jkV e-_- <br /> Applicant First Name: 0 <br /> Applicant Mailing Address: -?bo L <br /> City I)y 6Li/x/- State lc� ZIP C)4-5W Applicant Phone No: C1,\'5 — <br /> Water Supply: E]Public 8—OV-sile Well Sewage Disposal: 0 Public EjeTptic System <br /> Will there be any sale of firearms? El Yes Cj-1Tb— <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,all the above i rmation is true and correct Date: <br /> Applicant's Signature: � U-Tz> 1171 0 7 <br /> STAFF USE ONLY <br /> I G/P Designatior(CA1 I Zoning: C--e—( Use Type <br /> DEPARTMENT APPROVED DENIED DATE k:le <br /> Development Services Planner Name: F <br /> Building Inspection <br /> Environmental Health Div TV I <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: <br /> Remarks:ypmc -CRMD�a OHl� <br /> Occ.Grp. <br /> Acceptedas Complete: Date: <br /> F:NDevSvc\Planning Application Foffns\Business License(Revised 03-09-09) Page 2 of 7 <br />