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o�qut�••c <br />. t <br />•l•tL•• eiS�• <br />APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE <br />Td BE.C6MOLETED BY THE APPLICANT PRIOR TO M' ING'THE APPLICATION` - <br />Business Information <br />TAMW Business Name: F-01tSA' , 541Business <br />Address: j <br />Cross St (,e L 'r - <br />DBA Mailing Address; MOO)(Z41 <br />City: /�> <br />Phone #: 'Lp'g — 7 00fa <br />Assessor Parcel Number(s): <br />EmailMAIL— Dm <br />Other Businesses at this Address: <br />Previous Business at Address:aq(z ca - <br />Description of Business Operation:: <br />Type of Organization: --Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: ( <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: 14Applicant <br />First Name: to <br />Applicant Mailing Address:1 P"6el; <br />City L-47411-1;' IZD I Statee <br />—1000, <br />, Water Supply: Wubiic ❑ On-site Well <br />Sewage Disposal: M Public ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes IX No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all the above information is true and correct <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 <br />arising from the Owner/Agent's project. <br />Applicant's Signature: <br />Date: <br />_ .......... •- STAFF USE O L. <br />G/P Designation: C, Zoning: - Use Type: ¢ R /'. <br />DEPARTMENT APPROVED DENIED <br />DATE <br />Development Services Planner Name: j <br />' <br />Building Inspection <br />Environmental Health Div <br />62 <br />Fire Warden <br />Public Works <br />M.H.C.S.D. 4 <br />License Approved For. T /[� j 0' ill I I 1 <br />l` 1 1 ' <br />Remarks: <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/AppiicationsForms&Handouts/PlanningApplications/Business License (Revised 11-14-11) <br />Page 2 of 6 <br />