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EL"' )" E IV E D APPLICATION -- BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />APR 3 0 2015 BUSINESS LICENSE .90. <br />TO BE VZMWftWIT13Y THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: ,�,•V.r3 /k-�tS�CWIS <br />Business Address: 3 P C $,vC5 <br />Cross St <br />DBA Mailing Address: y/- ,om -5 pr► �� <br />City. ,sfpG trri�� State: ZIP:5.� r <br />Phone #: X-1714- 7 S d/J <br />Assessor Parcel Number(s): J J q - %DO- 0,2 <br />Email a4Ap"J ps (zM ,hem <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: A& t �rri <br />Type of Organization: • 9� Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br />Estimated Number of Full Time Employees: I <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: JC rvi <br />Applicant First -Name: f rV <br />-Applicant Mailing Address: Fo'* j v`rc les c <br />[city ,sled ie„ 1J State- CAZIP ?_S)()_, <br />Applicant Phone No: X?- - 99a -%r03 <br />Water Supply: JPublic ❑ Onsite Well <br />Sevsge Disposal: ❑ Public ,� Septic System <br />Will there be any sale of firearms? ❑ Yes )] No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all the above information Is true and correct <br />1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its <br />agents, officers and employees from any claim, actlon or proceeding against the County <br />arising from the Owner/A ent' project. i <br />Applicants Signature <br />Date: <br />11 <br />STAFF USE ONLY <br />GIP Designation: Tt— <br />/�,Yy <br />Zoning: f - L, Use Type:i} J11)UJ.W k r& l 01"-%cej-/�t�f7i14oit'Vf j?f t�S Li •C <br />DEPARTMENT <br />APPROVED <br />DENIED <br />DATE <br />Development Services <br />A <br />Planner Narne:'__711 <br />Building Inspection <br />Environmental Health Div <br />.sZIQO t0 <br />30 f.r <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For. /u-C?,n L 6�ye- oe.. e <br />Remarks: UCe,,,i 61-ilOOY6 & -Moo(A l <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/AppiicatonsForms$Handouts/Planning4plicationslBusiness License (Revised 02-2415) <br />Page 2 of 6 <br />