Laserfiche WebLink
Q APPLICATION 103USINESS LICENSE <br />(�SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />N: •� jJ1% 1 6 2.008 <br />Y.��t`n SUSIN LICENSE NOMI) -06 <br />�9LlFOR�`P NVfF�Qi�R�t.NT=HEALTh <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: e4u. & 2 <br />Y I <br />Business Address: / $ -Ire, L p Cross St <br />DBA Mailing Address:&L/dCity: <br />Phone #: -1074-X <br />Email <br />S ? a C' I t. "State: ZIP: 16 26 <br />Assessor Parcel Number(s): 9��_ �Q _0 <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Type of Business: <br />Type of Organization: ❑ Single Owner <br />, Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />v <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant last Name: <br />Applicant First Name: -7 . <br />Applicant Mailing Address: 3- _ CdU ik <br />City <br />State C,C� <br />ZIP CJS eS <br />Applicant Phone No: gyf (, .� 0 _ k3 5z <br />Water Supply: (]Public ❑ On-site Well <br />Sewage Disposal: R' 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, all the above information is true and correct <br />Applicant's Signature: <br />Date: <br />d I/ 2 J o g <br />STAFF USE ONLY <br />G/P Designation: <br />Zoning: — <br />Use Type: <br />DEPARTMENT <br />APPROVED <br />DENIED <br />DATE <br />Development Services <br />Building Inspection <br />Planner Name: <br />Z <br />Environmental Health Div <br />a <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />Sheriff (Junk Dealers Only) <br />License Approved For: <br />Remarks: _ <br />i <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F:\DevSvc\Planning Application Forms\Business License (Revised 05-01-08) Page 2 of 7 <br />