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-1 6, <br /> APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> $ �:'• BUSINESS LICENSE NO. <br /> 4CfPpFRa <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: ` S C <br /> Business Address: 1 V �� Cross St rj <br /> Mailing Address: 1City: T L State: ZIP973(� <br /> Phone#: n_ - Assessor Parcel umber(s): — U — <br /> Other Businesses at this Address: <br /> 1 <br /> Previous Business at Address: <br /> Type of Business: r i Q 5 w Q,( S E C 0 1 .2003 <br /> k <br /> PERMIT/SERVICES <br /> Type of Organization: Single O ivner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: �j Applicant First Name: <br /> Applicant Address: 2 ' r <br /> Cityr(`Q S ateC ZIPCf Applicant Phone No: <br /> Water Supply: ❑Public 921O -site Well Sewage Disposal: ❑ Public L2rSeptic System <br /> Will there be any sale of firearms? Yes No <br /> NOTE: ANY CHANGE F.00Cblr±NCYVPREQUIRE NTS AND NECESSARY BUILDING PERMITS. <br /> Applicant's Signature: Date: — 3 <br /> STAFF USE ONLY <br /> G/P Designation: Z ning: Use Type: <br /> DEPARTMENT A P OVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden C,6.L <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For: <br /> Aar iie t)t <br /> Remarks: <br /> Accepted as Complete: Date: <br />