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a�s AL <br /> ( OF ESCALON <br /> Ir Return this form with Tax to: <br /> City of Escalon <br /> CENSE APPLICATION 1854 Main Street <br /> ❑ RENEWAL p P.o. Box zas <br /> Make 6hV in printed information where necessary Escalon, CA 95320 <br /> NEW BUSINESS 96 JUL I S E TYPE OR PRINT.W (_5 1 —5 C—A 2 4 <br /> (209) 838 3556 <br /> BUSINESS NAME / �/� <br /> BUSINESS LOCATION(Complete Address,�City,State,Z/ <br /> (�J/�l�,L/{/� v/J /v"A°iV( ✓ �L/ <br /> BUSINESS TELEPHONE OWNER'S HOME TELEPHONE DATE BUSINESS STARTED IN ESCALON <br /> BUSINESS OVffiER OWNER'S SOCIAL SECURITY NUMBER — <br /> iw l' eat x e l '?- <br /> HOME ADDRESS(Complete Address,City,—State,Zip) <br /> IS APPLICATION FOR ❑ SOLE PROPRIETORSHIP hPARTNERSHIP CORPORATION ATTACH SEPARATE LIST <br /> (LIST ALL PARTNERS) (UST OFFICERS&TITLES) IF NECESSARY <br /> NAMEMTLEOME AD ESS(Complete Addres State,Zip) (AREA CODE)PHONE <br /> NAMElrITLE HOME ADDRESS(itVffiplete Address,City,State,Zip) (AREA CODE)PHONE <br /> NAMErITLE HOME ADDRESS(Complete Address,City,State,Zip) (AREA CODE)PHONE <br /> RESALE NUMBER(BOARD OF EQUALIZATION) STATE EMPLOYER I.D.a FEDERAL EMPLOYER I.D.NUMBER <br /> /< (, e/ --.4p i- 5, 11-//--/ -7d Z 7 346�' <br /> TO CALCULATE YOUR TAX, USE CATEGORY IN SECTION C (OVER) <br /> LING,INFORMATION �^ / �j,(/L� NOTICE <br /> NAME �! v '/MW `S a� Yt�� THIS IS ONLY AN APPLICATION. <br /> ADDRESS I S U �1y �'PIIRW`I APPROVAL OF CITY DEPARTMENTS <br /> CI—Y ZIP IS NECESSARY BEFORE THE <br /> lV f `D All �$ BUSINESS LICENSE IS ISSUED AND <br /> J OCCUPANCY IS GRANTED. <br /> PLEASE CHECK APPROPRIATE BOXES: <br /> YES NO <br /> ❑ Are you renting Commercial Property to a business? If yes,complete back of application.(Section A) <br /> Do you pay rent for office,work station,storage,etc.space? If yes,complete back of application.(Section B) t <br /> Q Xr Will business be conducted in your home? (Home Occupation Permit required if in Escalon Call Planning Dept.at 838-3556) <br /> T� Do you have any coin-operated machines(any type)on promises^, if sO how ma-.'y'': <br /> Q Provide name and address of owners of coin-operated machines on back of application(Section B) <br /> TYPE OF BUSINESS(Give full description) <br /> WE CANNOT PROCESS YOU LICENSE WITHOUT A SIGNED APPLICATION. PLEASE SIGN AND DATE APPLICATION AND RETURN WITH FEE. <br /> AFFIDAVIT: I hereb a under penalty of p ,that the reported information is true and correct to the b st of my knowledge. <br /> (/P <br /> _ DATE i <br /> SIGNATURE a.. � <br /> AVOID <br /> , PROMPTLY <br /> APPROVED DENIED BY REASON <br /> OFFICE USE ONLY PLANNING <br /> RECEIVED BY <br /> DATE BUILDING <br /> FIRE DEPT. <br /> CASH 17-1 <br /> AMOUNT RECEIPT fl CHECK❑ PUBLIC WORKS <br /> HEALTH DEPT. <br /> SIC CODE ARTICLE CHAPTER POLICE DEPT. <br />