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REUMVED APPLICATION - BUSINESS LICENSE <br /> i\ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> " 1 APR 2 0 20'1 BUSINESS LICENSE NO. oL' <br /> \c 7- <br /> 1, ENVIRONMENTAL HEALTH <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: C, " .a <br /> Business Address: `� t C jar (,)C P-C Cross St q Ci .F <br /> DBA Mailing Address:y y C CC �4 Ci State ZI £� <br /> Phone#: 3f113 Assessor Parcel Number(s). I Vt—V �Z <br /> Emai': <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> o � <br /> Description of Business Operation:: /� h <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: ry Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address:' . r <br /> 2C, State ' 7_I Applicant Phone No: J <br /> Water Supply: []Public On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes XNo <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 .— <br /> agents, officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agen project. <br /> , <br /> i <br /> Applicant's Signatureofi <br /> .-� <br /> STAFF USE ONLY <br /> G/P Designation: V Zoning: (/ Use Type:1�^0` <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. r <br /> License Approved For. <br /> Occ.Grp. LIM <br /> Page <br /> Ni2o 6 <br />