Laserfiche WebLink
RECEIV?D <br />AN 1 1 2016 <br />ENTAL HEALTH . <br />' /SERVICER <br />f-J-3-/(.�2 <br />APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO.�-' _ <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: OLIN C444 -or- P Lk4a L 1 (2rz <br />Business Address: 2(,olvt) S'�-6ANTPc tzcA1> Cross St 11'!14 STtZ�tT <br />DBA Mailing Address: AMC- City: —_)ZAC-y State:C-k ZIP: �"7y@�{• <br />Phone #: of . $3S" • 5424- Assessor Parcel Number(s): ,� ,j • lJ� <br />Email: 7-e &Vn Oil CZnm <br />Other Businesses at this Address: <br />Previous Business at Address: sicME <br />Description of Business Operation:: MAN lA FA CTU.rZ I N C cJc_G -W !� (C�j,Pct_� p 15 BU71 O <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br />Estimated Number of Full Time Employees: ?i / <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: Wn (712 LL(_-( <br />Applicant First Name: 'TVzI l" <br />Applicant Mailing Address: Z(p .(;&A NTA (Zo R17 I 7YZA C A <br />City —TVA -01 I State C_k ZlPCt56D.44Applicant Phone No: 2,013.2-2- ( , $-Z,(jl] <br />Water Supply: ❑Public PC,On-site Well Sewage Disposal: ❑ Public trSeptic 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 />I, affirm, under penalty of perjury that all the above information is true and correct <br />I, the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its <br />agents, officers and employees from any claim, action or proceeding against the County <br />arising from the Owner/Agent's project. <br />Applicant's Signature: _fal� 1� 1__�J <br />Date: <br />STAFF USE ONLY <br />tt <br />G/P Designation: i Zoning: 1 - i J ,j t, Use Type: Y <br />DEPARTMENT APPROVED DENIED DATE <br />Development Services Planner Name: 11n 1l <br />Building Inspection <br />Environmental Health Dive <br />Fire Warden r SLC <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />Remarks: L � • L]� I �L Cl3`d �L . -iX ti 1;/C <br />Occ. Grp. <br />Accepted as Complete: Date: <br />F/ApplicationsForm s&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 2 of 6 <br />