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0.°"'" APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUN(T'DEVELOPMENT DEPARTMENT <br /> OCT 29 2015 <br /> BUSINESS LICENSE NO �OV��� <br /> FNMRQNMENTAL HEALTH <br /> PFRMITISERVICE5 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: l' •( —ywc <br /> Business Address: 2116 f,J* FR—t pV 2W Cross St <br /> DBA Mailing Address: 211e, (,�Jr}% ,��� pr City: 7aC"*_,7CState: r14 ZIP:9S:7-0J— <br /> Phone t(aa Assessor Parcel Number(s): . — Off <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: e'la a[ •[ !/i'G{_. ^/;O/j j% <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant last Name: Applicant First Name: �M <br /> -Applicant Mailing Address: -IsAly, 4r C&Z'iu•C cz;* , <br /> City State ZIP 90If Applicant Phone No: 02 9Alf I ire 2 . <br /> Water Supply Public ❑ On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes f4,No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> t,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 <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: cla Zoning: - Use7ype: �— <br /> DEPARTMENT APPR D DENIED UA 1 E <br /> Development Services Planner Name: <br /> Building tnspection <br /> Environmental Health Div y yam, 106" <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. - -- <br /> �r _ <br /> LicenseApproved For. t.,n4cwTe <br /> uS <br /> Remark — 11 <br /> Zte.Grp. <br /> Aczzpted as Complete <br /> F1ApplicadonsForms&HandouWPOnningAppiicationsBusiness License(Revised 02-24-15) <br /> Page 2 of 6 <br />