Laserfiche WebLink
"'ECE <br /> IV <br /> APR 01 26i) <br /> ENV]RONM!r !TA-LWAqh <br /> PERMIT/Say&--' <br /> APPLICATION-- BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` BUSINESS LICENSE NO._ f X —l 5 UGry <br /> 1i;v�6W <br /> TO BE COMPLETED BY THE APPLICANT.PRIOR TO PH-ING THE APPLICATION <br /> Business Information <br /> 8uslnessName: v CIL'r —IrvZn <br /> BusfnessAddress: 1 5 tt s t Ood t1oV i�1 <br /> DBAAIaWMAdd ress: .0. City O(}� �ic7 Stale: cal ZIP: jZ�� <br /> Phone#: Zo Li81 lAssessorParcelNumberr(s):' <br /> Finaff: <br /> Other Bustnesses al this Address:' tVq-P— <br /> Previous Business at Address: —TYN O WVt--- <br /> Description of Business Operation:: k <br /> Type of Organtzatron: ❑ Single Owner ❑ Partnership Corporation ❑ Otw. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Z <br /> Applicant Last Name: A \et-, I AWWnt Ftrsl Name: KA,IN VIA 4p <br /> Applicant Malting Address: P,0, 12.11 <br /> CdYV3001 1OviG State ZIP"4 Applicant Phone No: Z 0 —I <br /> Water Supply: ❑Public I_On-site Well SewageDisposal: ❑ ubila fq�_SepticSystem <br /> LVd 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 Date: <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its <br /> agents,officers and employees from any claim,action or proceeding against the County 2 l <br /> arising from the Owner/Agent's project 1 (ZD 1 <br /> Applicant's Signature: 1 <br /> STAFF USE ONLY <br /> GIP Designation: c Zoning: r_G <br /> DEPARTMENT APPROVED DENIED AT <br /> Development Services ✓ Planner Name: <br /> T <br /> Building Inspection <br /> Environmental Health Div ~�. �„ L� 4 57(l< <br /> Fire Warden tV 00eqW <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: r <br /> Remarks: - /70 Ai J r e n e y-n ., ! 4%T. M,f� <br /> r ' <br /> 32 Occ.Grp. <br /> Accepted as Comp:ele: pate: <br /> F/AppiicationsForms&Handouts/PlannbgAppffcalions/Business License(Revised 02-2415) <br /> Page 2 of 6 <br />