Shmorhuni
'CITY OF LA QUIN
79-05 Cela t9fedi
P.O. Box 1504
,Le ouleNoCA.9221
(1119) 91111-!2411
564-2246 PLANNING DIVISION ZLD C 6/07
Read each condition listed on the rev;-rside side of -this orm to see
the proposed activity can comply with the City's Home occupation
Regulations. $35.00 fee
TYPE OR PRINT IN INK
APPLICANT'S NAME rA,'Q. R"IPHONE Z,/
PROPERTY OWNER • n PHONE
PROPERTY ADDRESS 3 - l 'Z4- A UU: - va P o
1 f_ (Street,) i-% — —
to
Type of residence (Single, Multiple, mobi
Type of business
Brief descrip 'on 9f hpy the bus will
cl—
a
Number of persons involved in business _
I -,r" w
List names of persons employed
Square footage -of usable floor area n
house (exclude garage) 1 'Zo 0
Location and square footage of area of
business activity in home (example:
bedrooms; � 5 �q are feet)
home,t.etc. )
to
00!1!$jd#4i0489tftp23-89 i0
10 CASH i TOTAL S 35.00
Description of machinery,ipment, and supplies being used in the
business operation 11.1i 'YYLE7
I have read and un t nd and agree with the conditions by which a
home occupy ' n is all d tions reverse
g�
�WFM.CANT, SIGN TURE 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.
• ff R • • • • R R R t R •
"PROVED ��f� Initials gv- Z3- e 9 Date
CONDITIONS ATTACHED
DENIED -Initials Date
LQHOMOCC.PRT