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Qa4utn. <br />V=; • � til �P j •'�� <br />RECA/1- APPLICAT& - BUSINESS LICENSE <br />MAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />NOV 0 4 2013 1 BUSINESS LICENSE NO. C- -- t 3 0 0�-R 9 <br />TO BE CO WrHE APPLICANT PRIOR TO FILING. THE APPLICATION <br />Business Information <br />Business Name: AUBURN 7700 INC <br />Business Address: 444 MOSSDALE RD LATHROP CA 9 390ss St MOSSDALE RD AND I-5 <br />DBA Mailing Address: SAME City: State: ZIP: <br />Phone #: 209-234-1256 Assessor Parcel Numbers): 3 9 - 0 W» 6 <br />Email: RAKH118609@GMAIL.COM <br />Other Businesses at this Address: NA <br />Previous Business at Address: <br />Description of Business Operation:: GAS STATION AND CONVENIENT STORE <br />Type of Organization: ❑ Single Owner ❑ Partnership [X Corporation ❑ Other: <br />Estimated Number of Full Time Employees: 2 <br />Estimated Number of Part Time or Seasonal Employees: 2 <br />Applicant Last Name: CHAWLA <br />Applicant First Name: RAKHI <br />Applicant Mailing Address: 2306 COVERED WAGON LN <br />city ROCKLIN I stateCA <br />ZIP 95765 <br />Applicant Phone No: 925-400-7118 <br />Water Supply: []Public IX On-site Well <br />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 />I, affirm, under penalty of perjury that all the above Information is true and correct <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'sproject. <br />Applicant's Signature:�4z,� �l `^' <br />Date: 10/24/2013 <br />STAFF USE ONLY <br />G/P Designation: Zoning: C F5 Use Type: �s U 6,j « — K / 1 Jr / ✓/ c E? <br />DEPARTMENT APPROVED DENIED <br />D T <br />Development Services Planner Name: r <br />LZ <br />Building Inspection <br />Environmental Health Div iVi <br />Fire Warden;�,{� <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />-1-% C -A. / G w <br />Remarks: <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicatlonsForms&Handouts/PlanningApplications/Business License (Revised 11-14-11) <br />Page 2 of 6 <br />