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21 �TY OF LAOUtNT/
HOME OCCUPATION PERMIT
APPLICATION
13-05 Calls tstafe
P.O. Box 1504
s Owlefo*CA. 922e3
. fa H) lis -1246
664-2246
ad each
PLANNING DIVISION
6/87
dit
n sted on the severs e side
of this
form to see f
•
con o
the proposed activity can comply with the City's Nome Occupation
Regulations. $35.00 fee W
/
TYPE OR PRINT IN INK , _
APPLICANT'S NA
]PROPERTY OWNER
PROPERTY ADDRE
t
State
Z
PHONE :514- (D % (O0
PHONE
Type of residence (Single, !Multiple, mobile home, etc.)
Type of business - L e •A -y W of
Brief description of how the business will operate
Number of persons involved in busine
List names of persons employed
Square footage of usable floor are in
house (exclude garage) .2aa
Location and square footage of area of
business activity in home (example:
be�d�;�oomis; 125 square feet,)
`?tOPG.+r -V i h 6 ram,,p z X 1 a SPS �P
Description of machinSry, equipment, ands
Validation Stamp
105i8CASH f06TOTAL 13
i7-88 35.00
used in
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse side/).
4
6
LICJ S GNA DATE
LV
If Applicant is other than property owner, authorization of owner or agent
required.
OWNER OR AGENT SIGNATURE DATE
IMIPORTANT: False or misleading information shall be grounds for denying
your Home Occupation, or failure to comply with conditions listed on
reverse shall be grounds for revocation of permit.
• PROVED Initials �e 7%" o O Date
CONDITIONS A A NED
DENIED initials Date
LQHOlMOCC . PRT