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eA if- PLEASE RESPOND WITHIN-M.mn-WEEKS <br /> (LICEN-- SUBJECT TO APPROVAL IF NO RESPON4" `Y THIS TIME). <br /> SAN JC JIN COUNTY COMMUNII?CQEVELOPMEN ;E <br /> ATTN: OWEN (468-3230) <br /> " 1810 EAST HAZELTON AVENUE IENT <br /> STOCKTON, CA 95205 <br /> B.L.NO. <br /> RECEIPT NO. <br /> Y 3 )99a ANNUAL FEE: ¢d•w <br /> ENI o%� atRl r�uc� <br /> O's <br /> e`,; (J v <br /> Business No 0:tj0jdtjjBq(H diHerer�: <br /> Susln...Addreaefl. c(0 <br /> Other Businesses at thls Addreae: (�Pjjnf)j A49401- <br /> Phone; b7/ (p b&g A.......Pmoel Number(.): ,.�1 <br /> Melling Address: O {1 I\�JI/�)11 <br /> Typo of Buslnese; (.i-f // <br /> Type of Orgenizailon: ❑ Single Owner ❑ Padnmshlp Corpomtlon ❑ Other: v <br /> Estimated Number of Full Time Employees! 3I E�ettimmoled Number of Pad Time or Seasonal Employees: <br /> Business Owner(.)Nem.: 11 1ye� YLJ' <br /> Business Owner(.)Address: 5 0y-A, ,g a f <br /> Manager's Nem.: n n red a •O..] <br /> Pmvlous Business el Sualness Addreae; l S <br /> Other Local Business Locations(Address): <br /> Water Supply: y1publi. ❑ Onalte Well Seweg.DI,Pneal: Public ❑ S.ptic System <br /> WIII Ihere be any retell sales of pistols,revolvers or other concealeble firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF CCUPAEOU7 BUILDING IMPROVEMENTS AND NECESSARY BUILDING PER ITS. <br /> Applicant's Signature: UAAL Dete: 6-p'j <br /> Oan...I Plan Dealgnatlon: C Zoning: `' G <br /> DEPARTMENT APPROVED DENIED A BY DATE <br /> Development Services Z` <br /> Building Inspection <br /> Environmental Health Div _P7 <br /> Alr Pollutlon Control Diet <br /> ShemlB(Ilrearm W..Only) <br /> /-5,d <br /> Fir.District E45e <br /> License Approved For: '`[ "a"IC5 <br /> TOF(MiC [ o <br /> Rem.A.: y } G/7tt <br /> )Gc L• • L /c� <br /> V <br /> AccaprduCp111G ate: is s �� 'a �' -si • i vOs1e: <br /> Coplae:WHfTE-DevelW.nt,GREEN-Building,CANARY-Fire Dlalrlct,PINK-Envlronmem.1 HeeNh,GOLDENROD-APCD <br /> ��• `'} ` `„'• ! , �,. r- ,,.. i PA-BI-LG Rev. <br /> .Q may- k <br />