Laserfiche WebLink
APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> c4CiFORa`P <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: r1i Ke. j,"f L 5L,0eN J O rG S <br /> Business Address: 2-7-1(2 C + Cross St <br /> DBA Mailing Address: L-{ _10-11 City: S �o f t� o ZIP: <br /> Phone#: 21� _Yj z7 -2, Assessor Parcel Number(s): <br /> Email: ry)r �� W L IL I o 6 o Yq In c,o L v i-1 <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: T f 'C- �� f `� c C C, U ed.✓ d (,t e,7 <br /> Type of Organization: A <br /> Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: I Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: VI L L (o Applicant First Name: <br /> Applicant Mailing Address: j KeLLe,Y 1) <br /> City y t-oc 1r,+6tj Slate CA I ZIP 1 S LU / Applicant Phone N4..2- <br /> Water <br /> :ZWater Supply: ❑Public ❑ On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes YNO <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 /> I,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its �_ D`1— / <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: <br /> STAFF USE ONLY <br /> G!P Designation: C Zoning: Use Type: S P J 1(e - Y <br /> DEPARTMENT APPR91VED DENIED DATE <br /> Development Services Planner Name: L1 L <br /> Building Inspection <br /> Environmental Health Div PZ <br /> �� <br /> Fire Warden L{ °� 5/C .7 <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> f� /1 e (J 1 le- re "AY- i I- Y� <br /> Remarks: <br /> Oce.Grp. <br /> Accepted as Complete: Date: <br /> F\DevSvc\Planning Application Forms,Business License(Revised 01-25-10) Page 2 of 7 <br />