Laserfiche WebLink
�oPaul�, .caI I I <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO I - Ah 2 D <br /> �<<FORN <br /> TO BE COMPLETEDY THE APPLICANTI FILING THE APPLICATION <br /> Business Information <br /> Business Name: QA( "wt-Z . f <br /> Business Address: Cross St <br /> DBA Mailing Address: rP3'2(qa A4 IeP City: State: ZIP:-TS <br /> Phone#: - ' / Assessor Parcel Number(s): (�f <br /> Email: " a rxQ 1149-t) Q 1 O t' <br /> Other Businesses at this Address: <br /> Previous Business at Address: 0 yl n <br /> Description of Business Operation:: +@.11 pt-e <br /> Type of Organization Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 10j< Applicant First Name: <br /> Applicant Mailing Address: AJ 100 <br /> City X14 PC1 State ZIP Applicant Phone No: 3(0 ®� <br /> Water Supply: ❑Public ❑ On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> i <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVE ENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under penalty 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 employees from any claim,action or proceeding against the County ! Q <br /> arising from the Owne Agent's proje t <br /> Applicant's Signature: <br /> STAFF USE ONL <br /> G/P Designation: Zoning: -`^ Use Type Maitu \( — W1111 1. <br /> DEPARTMENT APPROVED DENIED DATIf <br /> Development Services Planner Name <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden 1 <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For.X- uYva- -0— <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 7-14-11) Page 2 of 8 <br />