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D f ``�C <br /> tc3�111APPLICATION — BUSINESS LICENSE <br /> 700 <br /> 5SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ENVIRONMENT HEALTH BUSINESS LICENSE No.D q003f 3 <br /> PERMIT/SERVICES <br /> TO BE CO* ETEb BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: b►.,pt fi SSvG v f7 <br /> Business Address: 127 M ) Cro st <br /> Mailing Address: 72 N/ City: r C State: 04 1 ZIP: <br /> Phone#: . 7 25. L,I S 2 Assessor Parcel Numbeg( ):-1,V31-2 D - <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: r 'U 't <br /> LJ <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Q <br /> Applicant last Name: Applicant First Name: <br /> Applicant Address: \2_1,0 <br /> City S Avckkciv` I State C,P, I ZIP nt Phone No:C•-o!i 3 — 1 3 <br /> Water Supply. ❑Public [j Qn Site Well Sewage Disposal: _ ❑ Public [IoS pticSystem- <br /> Will there be any sale of firearms? ❑ Yes .®-4T6 <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REjQUTW BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above i 9110matiop i correct Date: <br /> Applicanrs Signature: 11"-2 <br /> STAFF USE ONLY <br /> G/P Designatlon:. Zoning: - af Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works _ <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For. <br /> Q , -© <br /> Remarks: <br /> Accepted as Complete: Date: <br /> F:1DevSvctPlanning Application Fonns\Business License(Revised 07-16-04) Page 3 of 8 <br />