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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. G 2- <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: tA 5e,�-} VcN'F'rArG <br /> Business Address: 303 (. N. W Lw}yN rLa..cQ Cross St 5{caev.s o — A}oc <br /> DBA Mailing Address: So� City: S-Fa L I,-a-e r-. I State: LrA ZIP:y {Z.0 e <br /> Phone#: (2„c,l cl G"S - 2_ E� o C, Assessor Parcel Number(s): <br /> L - U L 0 <br /> Email: NaNA Lr r. c -Frw cow. <br /> Other Businesses at this Address: N p <br /> Previous Business at Address: tjA <br /> Type of Business: <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation ® Other JeIN} VLN NrC <br /> Estimated Number of Full Time Employees: y D Estimated Number of Part Time or Seasonal Employees: <br /> Applicant last Name: N d e r 1 to Applicant First Name: a <br /> NTLI <br /> Applicant Mailing Address: 3 )' 3'0 N. New+o � ri. ...A <br /> City J State CA I ZIP ASto r ApplicantPhone No: (7�5) 14 (. 3 - 7- b a o <br /> Water Supply: ®Public ❑ On-site Well Sewage Disposal: ❑ Public ®. Septic System <br /> Will there be any sale of firearms? ❑ Yes IS No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above information is true and correct Date: <br /> Applicant's Signature: Ow /4,-L-_ _3 t- d 8 <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: 1 - Use Type: <br /> DEPARTMENT APPRQVED DENIED DATE <br /> Development Services ✓ Planner Name: �I SJd rf <br /> Building Inspection b <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For. _ <br /> Remarks: <br /> r a <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F Mev5v6rlanning Application Forms\Business License(Revised 08-30-06) Page 2 of 7 <br />