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Il 4 <br /> APPLICATION - - BUSINESS LICENSE <br /> .G SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '+*k'• BUSINESS LICENSE NO. 1✓J�- �, O Z-Z_ <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 8r %� V{ i�ti �s7 �-Y►PA►� �re�. , J ' ���c A�: � ti c•�p <br /> Business Address: a q 2 c, C., 9-16447- ),` ('ted, Cross St M <br /> DBA Mailing Address: S A 1-1 City: S-4 0C K•-1-0114 State:C4ZIP: <br /> Phone#: Assessor Parcel Number(s): 2.Q ZD <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: - :;C-;--J <br /> TO P\1 LC--tZ— 664 C-r-a <br /> Type of Organization: ❑ Single Oviner ❑ Partnership ] Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: ( 0 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: (-<v . Applicant First Name: 1 <br /> Applicant Mailing Address: "")l-q• f/fa tF t ,.y-r <br /> City �C t St teJ2�h ZIP-CfQ rte, " Applicant Phone No: �)--• Z <br /> Water Supply: ❑Public K On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? Yes No <br /> NOTE: ANY CHANGE OF OCCUPA14CY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm, under penalty of perjury that all the above information is true and correct Date: <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 project. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: J�1Z. Zoning: Use Type: , >�.:�wj ( f,'., <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services L-11, Planner Name: <br /> Building Inspection <br /> Environmental Health Div //2-- <br /> Fire Wardentd��,�zcl�` <br /> Public Works <br /> M.H.C.S.D. -- <br /> License Approved For: <br /> r� lit, �L�'�'J' � ! •�,%� � �.�.,. (�. <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/Plannin Applications/Business License(Revised 11-14-11) �OnJ iJ <br /> Page 2 of 6 <br />