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a'"`� "7 — ro - aor� <br /> APPLICATION BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .: :• BUSINESS LICENSE NO _ -_1 V�� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: C e Aqidgaw i <br /> Business Address: 14. Loo ,-c-e R p Cross S (La P S <br /> DBA Mailing Address`. J3 �%, P fl City: C Slate:C(+ ZIP: q_&3o <br /> Phone#: 2 '0 - 652 Assessor Parcel umber(s): <br /> Emall: —DOW3 ti ,- f , , (.C ? <br /> Other Businesses at this Address: r^ <br /> Previous Business at Address: <br /> Description of Business Operation:: New G' if cew ,n ,5 a a Pn t71 S't oo <br /> qui Ie c� , nj `r&rU <br /> Type of Organization: ingle Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: W Applicant First Name: I C`A'D tr' <br /> Applicant Mailing Address: 1` 0y y, Ccs rn <br /> City rQ G State C4 z1P qS 377 Applicant Phone No: 2—t C.( _ 3,30 — (p <br /> I Water Supply. blic ❑ 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 /> 1,affirm,under penalty of perjury that all the above Information is true and correct Date: b23/r <br /> I,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its ( I <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the OwnerlAgent's project. <br /> Applicant's Signature: o"_ <br /> STAFF USE ONLY <br /> GJP�signa6on: Zoning: Use Type: { <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> t Environmental Health Div <br /> Fire Warden <br />' Public Works <br /> M.H.C.S.D. <br /> { License Approved For <br /> { <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F;0evSvc"ann1ng Application ForrnM8"ness license(Revised 01-25.10) Page 2 of 7 <br />