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APPLICATI01F BUSINES LICENSE <br />r `? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />N: ;{ <br />BUSINESS LICENSE NO. <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: GG IV D Pue L <br />Business Address: f <br />4n <br />Cross St / Cir . <br />DBA Mailing Address: <br />Phone #: _ _ -7 17 <br />City: S ./ G C k T V 1Y State: GA ZIP: <br />Assessor Parcel Number(s): 23 <br />Email: <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Type of Business: �, c <br />Type of Organization: (Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: <br />Applicant Mailing Address: / (jtj/1/ 7-/2 <br />City <br />State CR <br />ZIP 9310 Applicant Phone No: 7v7- 3 84- 1 <br />Water Supply: []public ❑ On-site Well Sewage Disposal: ❑ 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 />1, affirm, all the above informatio is true and corr ct <br />Applicant's Signature: �- <br />Date: <br />/z v A C. -O 7 <br />STAFF USE ONLY <br />GIP Designation: Zoning: i Use Type: <br />I h� <br />DEPARTMENT APPROVED <br />DENIED <br />DTE <br />Development Services ,/ <br />Planner Name: <br />q • <br />Building Inspection <br />Environmental Health Btv <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />Remarks:t. <br />L -OT— l000 +6 L —0302(l <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F:\DevSvc\Planning Application Forms\Business License (Revised 08-21-07) Page 2 of 7 <br />