Laserfiche WebLink
i - <br /> ,oP4 .. APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> et . <br /> BUSINESS LICENSE NO. � <br /> � 11c•x:;a�P - <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING'THE APPLICATION <br /> S ivk-c A- Business Information <br /> Business Name: U <br /> Business Address: Cross SI <br /> 1 :4 1DBA Mailing Address: City: 04 Stale: ZIP. Z <br /> Phone 2 Q 0�s� — 5 (� tt Assessor Parcel Number(s): ' ) <br /> Other Businesses at this Address: / <br /> Previous Business at Address: / <br /> Description of Business Operation:: h 1 "a <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 3 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last <br /> Name: ll)-o C,>A Applicant First Name: la I h 6LC r <br /> Applicant Mailing Address: l fJ l CL S� 0 <br /> City Stale ZIP Applicant Phone No: <br /> Water Supply: ublic ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm, under penalty of perjury that all above information is true and correct Date: <br /> I, the Owner/Agent agree defend,indemni ,and hold harmless the County and its <br /> agents,officers and em o es from any clai <br /> M.actio r proceeding against the County II I S I Z <br /> arising from the Owner/ g nt's project. <br /> Applicant's Signal ure: <br /> STAFF USE ONLY <br /> G/P Designation: 1 Zoning: Use Type: <br /> DEPARTMENT If APPROVED DENIED DATE <br /> Development Services Planner Name: _ <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warde �Q odo s! <br /> Public Works <br /> License Approved For: <br /> 1 <br /> Remarks: <br /> a 1 Ooc.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicallonsForms&Handouts/PlanningApplicalions/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />