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APPLICATION - BUSINESS LICENSE <br />04' i 1 5 2007 <br />" SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />ENVIRONMENT HEALTH BUSINESS LICENSE NO. <br />PERMIT/SERVICES <br />TO BE COMPLETED BY THE APPLICANT THE APRLICATION <br />Business Information <br />Business Name: Lot ir,4D4,V L <br />E C --r-- - 1a N-0 F Ll i I <br />Business Address: 15 (, L#L <br />Coo <br />'1 11) 1 14C <br />Cross St <br />DBA Mailing Address: (4, 5 C C <br />Phone #: os — � 6 2, 6 9 2, <br />12 f >r <br />City: City , , - C--' -C <br />(3 Y) <br />State: C <br />Assessor Parcel Number(s): <br />Email: <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Type of Business: <br />cio <br />AC 024 C-2/ C! <br />Type of Organization: ngle Owner <br />0 Partnership 0 Corporation 0 Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: I rqID L <br />Applicant First Name: y 12 <br />Address: , <br />Applicant Mailing Add�re,� <br />R Y _L 1 7 (3 b).vd, <br />City :E� I C3y) ate <br />CN(- State �te <br />C_ 0 <br />ZIP S I <br />I <br />Applicant Phone No: �0c)-Lf 6)_ - 06S 2 - <br />Water Supply: XPublic ❑ On-site Well <br />Sewage Disposal: K Public El Septic System <br />Will there be any sale of firearms? El Yes <br />,No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />1, affirm, all the above information is true and correct <br />Applicant's Signature: <br />Date: <br />-7 <br />STAFF 'USE ONLY <br />G/P Designation: C_ Zoning: CA). <br />Use Type:I Y) -x <br />t h Y). <br />DEPARTMENT APPROVED <br />-Oftni <br />DENIED \Ij DATE <br />Development Services Ut <br />Planner Name: 0 UM6) <br />Building Inspection <br />Environmental Health Bir <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />\j <br />Remarks: Cke <br />0. k) C IXUA, <br />ill'?-)�y 124 <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F:\DevSvc\Planning Application Forms\Business License (Revised 09-12-07) Page 2 of 7 <br />