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eaalh, <br /> PLEASE RESPOND WITHIN TWO WEEKS. _ <br /> (LIC 3E SUBJECT TO APPROVAL IF NO RESPO : BY THIS TIME <br /> )- <br /> SA, iAOUIN COUNTY CBAI"NITY DEVE "�P(6/Jv/1J <br /> ATTN: OWEN (468-3230) t. <br /> �(g y&am X1 0 EAST HAZELTON AVENUE <br /> III^V�J\ V(a N npCKTON, CA 95205 <br /> W e.CNo.__ -._-tL-- -.I-L'S <br /> MAY 4 RECEIPT NO. (343fo <br /> ENVIRONMEENTALMTALHEALTH W <br /> PERMIT I SERVICES ANNUAL FEE: <br /> 70 6E COlAPIE KJ B°7NL nPPi ICANi MOD TO i Il ING.TM PpLICAI IOH <br /> Nml c s Neme: try �/c yQ� j TH n� DBA("di"srera): <br /> B..ln.ee Adar... 22_II V LZik�eicy - N 57,x5 <br /> Other Bush.....M this Address: ILL& g4& U7o-- <br /> Phons: I Assessor Pam.1 Number(.): <br /> Melling Addres.: (,.VI C� clrkit7CO <br /> Type of Business: J <br /> Type of Orgnnketlen: X Single Owner 0 Pednenhlp O Corporation O Other: <br /> Estimated Number of Full Time Employees: I Esilmaled Number of Pad Time or Sawmal Employees: <br /> Business Owner(s)Noma: yl',p k <br /> Bush...Owner(.)Addreee: <br /> Meneger's Hems: I&-/(- <br /> Previous <br /> L `t <br /> Previous Business at Business Address: e j / <br /> Olher Local Business Locations(Address): <br /> Water Suppfy: ❑Public On-s"e Well Sswepe Dlspoesi: O Public RI S.PtI.System <br /> Will there be any retell sales A pistols,revolvers or other concealable"rearm.? ❑Yes No <br /> NOTE: ANY CHANGE OF CCUPANCY WILL RE B VEMENTS AND NECESSARY BUILDING PERMITS. <br /> Appllcent'.Sign etu a Dal.: 5-2.3 y <br /> fSTAFF USE ONLY <br /> Generei Plen D.agnmlam C, (r 7>—, C-G <br /> DEPARTMENT APPROVED DENIED V DATE <br /> Development SW... 5 1 y <br /> Building Inepeollan <br /> Emironmsnlel Hsa"h ON -O'9/ <br /> AIF Pollution Conlrol Ole! <br /> Shod"(11.......1.enfy) <br /> Fire Dlelricl c- S <br /> License Approved For: !9 3 ,�^ }� Oy✓' <br /> le-151- ! qif eta 4 Le4,14 vkOA.J <br /> R.marka: 5-4-L71-:011 <br /> Aecapled ae Complete: Bets: <br /> Caples:WHITE-DevelopmeeL GREEN-Building,CANARY-FIre Di PINK-Emvl onmenlst Heats,GOLOENROD-APCD <br />