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1 <br /> I <br /> \1 / <br /> t,� If RECEIVED APPLICATION - BUSINESS LICENSE <br /> .' OCT O 9 200, AN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 11 <br /> ' `yJ BUSINESS LICENSE NO. �� C <br /> Community Development De <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: r <br /> Business Address: (p(A p cnm l r� Cross St <br /> DBA Mailing Address: PO C3o,,, 6919 ;o <br /> n, City: L State: 4j�Z I ZIP:"727 <br /> Phone#: 5 '� —3�L} SZ���(�� Assessor Parcel Number(s): <br /> Email: Sh n ron—n e-4-)e Y, n �bh L.tn4 (Qr� <br /> Other Businesses at this Address: KJ 1,4 <br /> Previous Business at Address: (('' <br /> Type of Business: -FY LAC K / FV-n \P f r-e f)n I r '?'Q-r i f t'its/ -C(),r <br /> corYl�r�y vel�,� cle�; 1 // <br /> Type of Organization: ❑ Single Owner ❑ Partnership [R Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: `) I Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: M Applicant First Name: Da y` <br /> i Applicant Mailing Address: <br /> CityState I ZIP �Z� Applicant Phone No: 4`[C(— g ZQ_(X�OC� <br /> La we i� I <br /> Water Supply Public ❑ On-site Well Sewage Disposal: R Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes [)l No <br /> NOTE: ANY CHANGE OF OCCUPA Y MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the abo • forTn tion true and correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY r / <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services / Planner Namely <br /> Building Inspection / �A <br /> Environmental Health Div <br /> r <br /> Fire Warden y <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) C� <br /> License Approved For: V k �, �)�! Lim' U yf �)'L U L.-) <br /> Remarks: <br /> C7� O0 1`I 3 n ,2 - <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSvc\Planning Application FonnsGusiness License(Revised 09-01-09) Page 2 of 7 <br />