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NED APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Egli M R 31 2016 <br /> BUSINESS LICENSE NO. 1 <br /> HEALTH <br /> [ TO BE COM LETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information _ <br /> Business Name: 5 D v C,i t C Y Cl-&S _ <br /> Business Address: J-731 1('A4s-t. Cross St C- 4 z -T <br /> DBAMailingAddress 7g3g (I-r,4S r City: � �ml State: UzIP: 91-.3oy <br /> Phone <br /> #: r(s): 140-M <br /> j <br /> _ 2� ---- ------ <br /> I tl: 20�'1- 3 L- /y Assessor Parcel Numbe <br /> ! Email SLl�u c t t �G'C.i� © Y k t}a o C4(-1 <br /> l <br /> Other Businesses at !s Address - -- <br /> Previou.Business at ddress: �•to n-c.Y (re <br /> D—escnption of Busine Operatio :: SL&VjGi r &E,-,+1t1 tjo-ran,,lc-r-S — ------ <br /> F'yi;e of Organization: Sing Owner U Partnership ❑ Corporation ❑ Other. <br /> Esiimated Nuniber of ull Time Er ployeos: EstImated Number of Part Time or Seasonal Employees: <br /> Applicant last Name:: ¢.P,� L\40 Applicant First Name:_S:�>IF_/UNl 8 <br /> A'vplicar2 iJtailing Addr ss: Q. <br /> Ii ''ry y le, <br /> State r� ZlP c s 33(a Applicant Phone No: 2O e1-(y`I O-Dy 4$ ---- -- �i <br /> I' old;Ic•r s upply: ❑ On-site Well Sewage Disposal: ❑ Public Septic System <br /> I' `v;lii;ttrorr.he any earms? ❑ Yes l0 1 <br /> I! Idt.)TE: ANY CHF UCCU ANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. !I <br /> 111I,affirm,undery of pe ury that all the above information is true and correct Date: ; <br /> 1,the Owner/Aree,to efend,indemnify,and hold harmless the County and its <br /> I� agents,officermploye s from any ciaim,action or proceeding against the County <br /> arising from thr/Ag s project. <br /> II <br /> I' <br /> Applicant's Signu <br /> Ir- --- - STAFF USE ONLY <br /> GIP Uesiynat on: Doing: �-_ Use Type <br /> T �jY��S r r1 n <br /> DEPARTh1Eld PF' VED DENIED � - C�rs,Ti:: <br /> Development Services —- Planner Name: -- i <br /> Buildin Ir>,xction - <br /> g <br /> Environment2l lfeaAh 4t— - -- "'1__ Sti 10 i!g LA-5-1 - !) <br /> Fire Warden TW--/ <br /> PubIICWOrf S ---T-------- _.._•{ <br /> M.H.C.S.D. ----- - ._..---------- --� ---... - ---- -II <br /> License Approved For. I r Y 11 <br /> Remarks. -- - u"�`— ---...-- - ---------- I <br /> Occ.Grp. <br /> ----- ----.--_ --- —--- -- — — -— 1 <br /> Accepted as Can IeW: Date: <br /> cep -- i <br /> F/ApplicabonsForns&Ha outs/Plann ngApplications/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />