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P(,lU�ly APPLICATION - B IILSS LIC"&SE <br /> o • ...... <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> App 2 8 <br /> BUSINESS LICENSE NO. <br /> •:c�d�. �;;�:. ENViRONMENT HEAUK <br /> rFOREN <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILIN =APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address: ? =� G� Cross St Ye <br /> DBA Mailing Address: o l p v o row City: <br /> Phone#: `dp S Assessor Parcel Number(s): <br /> Email: A e u I O 011 <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: C r–T5 <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 7– Estimated Number of Part Time or Seasonal Employees: 4— <br /> Applicant Last Name: � Applicant First Name: , <br /> Applicant Mailing Address: /`j S L. <br /> City li,ant Phone No: � S �; <br /> Water Supply: ❑Public Visite Well Sewage Disposal: El Public [3"�eptic System <br /> Will there be any sale of firearms? ❑ Yes g--Iq-o. <br /> INOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm,all the above information is true and correct Date: <br /> Z1 <br /> Applicants Signature: <br /> ��G/ 'v <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: (J -D Use Type: <br /> MDEPARTMENTAPPROVED DENIED DATE <br /> Develo ✓ Planner Name: <br /> BuildinEnvirovIf <br /> Fire WPublic <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: p.(d,P$ ( r, 1 p, Q t <br /> Remarks: – /(0 o o"'/ S <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Fonns\Business License(Revised 05-01-08) Page 2 of 7 <br />