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,a��'''h•.cQAPPLICATION — BUSINESS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> c�•..,r Q ,N;� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address: Cross St <br /> PDBA Mailing Address: t�� l ce q,, e 4• city: d �, l State: ZIP: Ajhone : ---/115;2- Assessor Parcel Number(s): CPO <br /> Email: 17n <br /> Az <br /> Other Businesses at this Address: <br /> Previous Business at Address: PU�i <br /> Type of Business: <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: V e, j"L/l �� Applicant First Name: �, <br /> Applicant Mailing Address: 7— <br /> city <"7 <br /> City (/ State ZIP �S Applicant Phone No: <br /> Water Supply: Public ❑ On-site Well 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 /> 1,affirm,all the above inf tion is ue and correct Date:: <br /> Applicant's Signatu . O f <br /> STAFF USE ONLY <br /> G/P Designation: I LZoning: — Use Typetro Milt �Zuk — C <br /> DEPARTMENT APPROVED DENIED , `1 — DATE <br /> Development Services Planner Name: . ' t <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden o <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) ENVIRONME ITAL HEALTH <br /> License Approved For. <br /> Remarks f2"1rCA4 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> FADevSvctPlanning Application FormsNBusiness License(Revised 03-09-09) Page 2 of 7 <br />