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<br /> :
<br /> APP '*SS LICENSE
<br /> ELATiON - S1s1
<br /> SAN 'OAQUIN COUNTY COMMUNRY DEVa0pME?IT DEPARTMEMT
<br /> D B.L NO. i
<br /> RECEIPT NO. 2'1Q0 l
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<br /> ANNUAL FEE:
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<br /> LOB
<br /> A,Name: /�/� .,.. .
<br /> I �)-- (.!'TOMDT! �f I OBA(ddiHerertt): (
<br /> Business Address:
<br /> �sabs j
<br /> Cther Businesses at this Address: j�ahf�r' j
<br /> Phone: QV _ L4&3-- Assessor Parcel Number(s): rl L 09 p 3 7& j
<br /> j Halling,address:
<br /> Type of 9usiness: U S E1-\ lhsLN
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<br /> Type of Crgsnization: ❑ Single Cwner �elowtnerehio ❑ Corporation C Cther.
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<br /> sdmated Number of Full—,,me noloyees: Esdmated Number of Pert Time or Seasonal Employees:
<br /> Business Owner(s) Name: I sS U R I N DL5 �T S H U N pR�, g-r-r; A
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<br /> f3usiness Cwner(s) Address: 1�,R\ v�, tam
<br /> Manager's Name:
<br /> Previous Business at Business Address:
<br /> ""her Local Business Locations fAddressl: NO j
<br /> 'Nater Sucply: \59 P-lblic C( Cn-site Well Sewage Diseosal• C Public
<br /> �, Septic System I ,
<br /> Will there bs any retail sales of pistols, revolvers or other concealable 5rearm3? a Yes -0 No
<br /> i .
<br /> NOTE: ANY CHANGE O OCCU ANCY WILL REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. j
<br /> j Acclicant's Signature: I Date:
<br /> ( 3ensral P!sn Cesignarlon: !'J'
<br /> Zoning: � —
<br /> i OE�ART�.IENT I APPROVED I CE'VIE7 I BY j QAi cc j
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<br /> Cevelooment Services 7 g 3r
<br /> Building Inacection I I I I
<br /> rnironmental Health Civ
<br /> .Sir Polludon Control 01st I j I
<br /> fSheriff(tlreann Was only) I
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<br /> Firs Clireict ( I I
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<br /> Ucense Approved For. Vro SgAr
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<br /> Accepted as Complete•, Dab:
<br /> Copkw WHITE-0evelopment,GREEN-Bullding,CANARY-Fin 0lstrict,PINtGEnvfronmerrtal Hoeft GOLDENROO-APCo
<br /> PA 8L.LG Rev.
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