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APPLICATION — BUSINESS LICENSE <br /> : ••,�.�..t.A <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO._ C,' <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: ��e 'P S ` <br /> Business Address: 3`'1 t( i� l k%A461CIC xve Crass St E v G <br /> DBA Mailing Address:3q+t n City.-<+c)C kn State: G ZiP: Sc.Q y <br /> Phone*.,-0C) 3 50-S6 Assessor Parcel Number(s): � o <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: 5f Single Owner ❑ Partnership ❑ Corporation ❑ Other- <br /> Estimated <br /> therEstimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: „50k k Ck 7-4,(, Applicant First Name: P► M p`A Co <br /> -Applicant Mailing Address: 7L/13 <br /> IGtn ow•� <br /> City k N C State e Z1P y 5 Zl Applicant Phone No: (/4 �/G j , <br /> Water Supply. •Public ❑ On-site Well Sewage Disposal: 9 Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes $L No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under penalty of perjury that all the above information is true and correct Date: <br /> 1,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 -3 \ -- <br /> ansing from the Owner/Agent's <br /> Applicanrs Signature: <br /> ST F USE ONLY <br /> GIP Designation: n Zoning: ;n Use Type: c_ t j CS <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: sc�% VZ2—'zol ] <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. TA40c, Pair pr /,3�aa t <br /> Remarks: As as c e �'J L 1 SCO <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsFonns&Handouts/PlanningApplicabonsBusiness License(Revised 02-2415) <br /> Page 2 of 6 <br />