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:2— <br /> APPLICATION ® BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 5 ynaaox <br /> Business Address: Cross St C�wisy-rw-\ <br /> DBA Mailing Address: State ck- 1 Z'95- "('o <br /> Phone#: 2—0(1\ 3 Oa 0(--) Assessor Parcel Number(s): 0 <br /> Email: Ulk��Swv)ko W1 (gym <br /> Other Businesses at this Addresi: <br /> Previous Business at Address: <br /> Description of Business Operatio :! <br /> Type of Organization:1 9 Sing Owner El Partnership El Corporation El Other: <br /> Estimated Number of Full Time 4iployees: Estimated Number of Pail Time at Seasonal Employees: <br /> Applicant Last Name: eApplicant First Name: <br /> Applicant Mailing Addiress: ty, <br /> City jp` 'State zlP(;"1 Applicant Phone No: 'Sol <br /> Water Supply: EIPublic On-site Well Sewage Disposal: 0 Public Septic System <br /> Will there be any sale of firearms� [I Yes El No <br /> NOTE: ANY CHANGP OF OCCOANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under per!ialty 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 employ t es from any claim,act on or proceeding against the County <br /> prof arising from the Owner/Agp1t. <br /> I Applicant's Signature: STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> eh t' <br /> a h <br /> DEPARTME APPROVED DENIED DATE <br /> Development Services' Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden 6JW 2---- <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: e Ck. <br /> =c. Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsFomis&Hadouts/PlaniingApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />