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--tb -I I <br />ctV.Ity. <br />.•*" <br />21 I —Ntr-7 <br />to kg silk< <br />1 • <br />•• ••:'? ergo <br />APPLICATION - uu,iINESS 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 />3usiness Name: C .1 \ \ S c1,0 ,,r\ 3c.,4,4z , t_ UL (. <br />3usiness Address: 7,c, CI -A `...J ft\ ( \ \ Q_ la i V Cross St <br />)BA Mailing Address: S N.A\ ..,.L., City: S tf q k-'04,--% State: ( A ZIP: <br />'hone #: , ,_\ '0 <4 \ -,,:k c, Assessor Parcel Number(s): 7-. 2- 6 - o <br />Email: rii,!, <br />)ther Businesses at this Address: <br />'revious Business at Address: <br />3escription of Business Operation:: <br />cs,T rvt.. <br />-ype of Organization: • Single Owner El Partnership [1] Corporation III Other: <br />Estimated Number of Full Time Employees: - e- Estimated Number of Part Time or Seasonal Employees: - ) <br />\ pplicant Last Name, - 6,,,.\,...._\ ts.Ne, IN Applicant First Name: i a NN„-1 y <br />kpplicant Mailing Address: t: ,N,Ni..... 3. <br />;Ity State ZIP Applicant Phone No: y <br />Vater Supply: ['Public • On-site Well Sewage Disposal: 0 Public 0 Septic System <br />Vill there be any sale of firearms? 0 Yes 17( No <br />IOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />, affirm, under penalty of perjury that all the above information is true and correct <br />, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its <br />igents, officers and employees from any claim, action or proceeding against the County <br />'rising from the Owner/Agent's project. <br />— <br />%pplicant's Signature: <br />Date: • \ 0.3 -H 1 i <br />A STAFF USE ONLY <br />VP Designation: i Zoning: / “. _ c. 0 Use Type: ni re._ /(7 6., • /0 ,-, k <br />DEPARTMENT APPROVED DENIED DATE <br />levelopment Services <br />17 <br />Planner Name: g ,- <br />iuilding Inspection <br />.nvironmental Health Div V 4662-L.-- 6(6/ff <br />ire Warden .1-'13-(1., .... ..'.; l-e 000 f-77 C.) <br />'ublic Works <br />1.H.C.S.D. <br />icense Approved For: <br />fil /4 / <br />:emarks: <br />OCC. Grp. <br />ccepted as Complete: Date: <br />levSvc\Planning Application Forms \Business License (Revised 01-25-10) Page 2 of 7