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Type of Organization: V Single ❑ Partnership ❑ Corporation Other: �\ <br /> Estimated Number of Full Tim Employees: Estimated Number of Part Time or Seasonal Employees: <br /> ranager's <br /> me: <br /> dress: <br /> ame: Q\ <br /> 1 I + <br /> siness at Address l L <br /> i <br /> 8usiriese Locado�rs(Address):ly: Public ❑ On <br /> Well Sewage Disposal: �( Public ❑ Septic System <br /> Will there be any retail sales of pistols, revolvers or other concealable firearms? ❑ Yes X No <br /> NOTE: ANY CHANGE OF O CUPANCY W LL REQUIRE BUILDING INPROVEMENTS AND NECCESSARY BUILDING PERMITS. <br /> Applicant's Signature: Date: • <br /> ..................:::::::::::::............................................. ................ <br /> IR:�:+::^i�ii:??tviiiiii:Ctii::`vi:::is Y:{<}::::::Cy:::?{i:!:ii::iij::•<?:>%i:;:?s��;`+T:ii::'t::i:y:v:?:ii::i:�i�::i;i:' <br /> ::i:>':::::: ::::::......: v::�v:::i::::::::::::i::il::':Y.iii:.:::::iii:.....:.....:...... ;;..; <br /> ....... <br /> :.. �(.1fT.:i ... .. .. <br /> i:! i::ii ii iiiiiii:':ilii:iiii:Ji:i::i:<?•:i::iiii:ilii}i:: ........... •::::::::::::............. <br /> General Pian Designation: �(, Zoning: Code Section Number. '' '�>' �-• <br /> DEPARTMENT APPROVED DENIED BY DATE <br /> Development Services j A '"•u r- ' ''" ' <br /> Building Inspection / �^ <br /> Environmental Health Div <br /> Air Pollution Control Dist <br /> Sheriff(firearm sales only) <br /> Fire District <br /> License Approved For: <br /> Remarks: ; j A i. L . + - �' vy%LO�'►PG�/ 6a�'7•/:/ �GL <br /> Accepted as Complete: Date: <br /> Copies:WHITE-Development, GREEN-Building,CANARY-Fire District,PINK-Environmental Health,GOLDENROD-APCD <br /> PA BLLG Rev.September 2,1992 <br />