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e4VIpl. c <br />�: •mac. ••.o� <br />,Q: •a <br />' •P <br />J <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. •�( <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: <br />Business Address: PYC Cross St <br />' <br />DBA Mailing Address: City: �}L!1::4,r v State: C+ ZIP: �o2GJ j� <br />1 <br />Phone #: 6 'k Assessor Parcel Number(s): <br />Email: <br />Other Businesses at this Address: <br />Previous Business at Address: fZ1CA-t2kCtY1 C <br />Description of Business Operation:: zt �t <br />Type of Organization: 19Ksingle Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: I <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name:1wyl <br />Applicant First Name: ( ) P <br />Applicant Mailing Address: 3 c <br />City ' StateJA- ZIP S �, <br />Applicant Phone NO: (gip ' S SY6 <br />,r Supply: ublic ❑ On-site Well <br />Sewage Disposal El,�ublic ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes Quo <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 <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 Ow /A nt's project. <br />Applicant's Signature <br />Date <br />STAFF USE ONLY <br />GIP Desiynatlon: �� _mooning: i_ ( <br />Use Type <br />DEPARTMENT APPROVED <br />DENIED <br />DATE <br />Development Services - <br />Planner Name: V I I <br />Building Inspection <br />- <br />Environmental Health Div <br />Z 0 <br />Fire Warden � <br />Public Works <br />M. H, C. S. D. <br />License Approved For: <br />J <br />Remarks: l_ uV S L 1 D- <br />Occ. Grp. <br />Accepted as Complete: Date: <br />F \DevSvc\Planning Application Forms\Business License (Revised 01 -25-10) Page 2 of 7 <br />