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1 <br /> oPQ�t">:_19160APPLICATION — BUSINESS LICENSE <br /> Q' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ::'• BUSINESS LICENSE NO. U 166 226 <br /> A�rFORa <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: /� <br /> Business Address: Cross St <br /> DBA Mailing Address: r <br /> t� �S City: State: ZI <br /> Phone#: Assessor Parcel Number(s): /� — 2-7 d — to <br /> Email: c <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: Q <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: p <br /> Applicant Mailing Address: <br /> City C State ZIP Applicant Phone No: ZdS <br /> Water Supply: �PtfFfic ❑ On-site Well Sewage Disposal: ❑ Public eptic System <br /> Will there be any sale of firearms? ❑ Yes o <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true a or ct Date: <br /> Applicant's Signatu' Z2,,,�_ & ��/- � <br /> STAFF USE ONLY <br /> G/P Designation: T L` Zoning: — Use Type: JicJffd�CSC 1n 0/S �p�dyj S/77 <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health givm. <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: S ' l n U <br /> �'e 07= P <br /> Remarks: 10, <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F.\DevSvc\Planning Application Forms\Business License(Revised 08-21-07) Page 2 of 7 <br />