ELDER'CITY OF LA QWNTA
78-05 Celle Eslede
P.O. Box I5O4 _
Le Oulnto,CA. 9224!
(619) 564-1246 .
664-2246
PLANNING DIVISIONT/�
5/67,'
Read each condition listed on the reverside side
of this
form to see f
the proposed
activity can comply with the City's
Home Occupation
Regulations.
$35.00
PROPERTY ADDRESS
.5-q-1190 a.vP. 7,kc
sO
TYPE OR PRINT IN
INK
APPLICANT'S NAME
�� idnne �uRtor�
PHONE
PROPERTY OWNER
PHONE
PROPERTY ADDRESS
.5-q-1190 a.vP. 7,kc
te"7
( Street )
c7+� �y1h14,
9 �s3
(City)
(State)
(Zip)
Type of residence
(Single, Multiple,
mobile home,
etc.) Siv,GIf-
Type of business
:ZL.�e2
Brief description of how the businessiw} ll operate
Number of persons involved in business��), SsIC�
List names of persons employed I-pl
Square footage of usable floor area in
house (exclude garage) Llc," -1,11e — Validation Stamp
Location and square footage of area of
business activity in home (example: 005182 to 8663 02-05--88 S.0
Z1,7L1,/ bedr 125 square feet) �Q S.{? C�i;a'!i i iLJ'T�;!_ S 35.00
0 n t-ni rVA , . Lr U aX.y
Description of machinery, equipment, and supplies being used in the
business operation k W 0. +�it.�. (014 a*A-
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse side).
APPLICANT SIGNATURE DATE
If Applicant is other than property owner, authorization of owner or agent
required.
OWNER OR AGENT SIGNATURE DATE
IMPORTANT: 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.
' 'CITY llSE ONLY
X --APPROVED Initials
CONDITIONS ATT HED
DENIED Initials
LQHOMOCC.PRT
4- Date
Date