Laserfiche WebLink
N <br />,APPLICATION BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT <br />DEPARTMENT <br />BUSINESS LICENSE NO.Kk I c71w1 `S - <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />B siness Information <br />Business Name: <br />(9S (`Y) A kthol4ew <br />Business Address: G <br />Cros St <br />DBA Mailing Address :�� /I <br />City:State: ZIP:rb2 <br />C J <br />Phone #: IN -CA` <br />Assessor Parcel Number(s): 1 ` 41 <br />Email. <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Ful Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: P Im 16c,Applicant <br />First Name: ' �1 <br />Applicant Mailing Address: - C <br />City tate ' <br />ZIP��� <br />Applicant Phone No: - lO <br />Water Supply. ❑Public L/i On-sile Well <br />Sewage Disposal: ❑ Public Septic System <br />Will there be any sale of firearms? ❑ Yes No <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 Owner/Agent's prof 7et. <br />Applicant's Signature: <br />Date: <br />STAFF USE ONLY <br />G/P Designation: C <br />Zoning: - Use Type: U A U Vs- <br />mv - L <br />DEPARTMENT <br />APPROVED <br />DENIED <br />DATE <br />Development Services <br />Planner <br />�1 <br />Building Inspection <br />Environmental Div <br />� <br />EL <br />�Htealth <br />Fire Warden f710( <br />W <br />f <br />Public Works <br />/ <br />M. H.C.S. D. <br />_ <br />License Approved For: J U lql r� � (� h `. -V VPS . 13 a -)N I <br />I. <br />Remarks: <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicalionsForms&Handouts/PlanningApplications/Business License (Revised 11-1A-11) <br />Page 2 of 6 <br />4 <br />