HALL- r-
0
"CITY OFLAOUW
79-105 calNballese
P.O. Box I504-
K,LOuIeW&CO.9226
16191964 -t=ots
664-2246 PLANNINGDIVISION.).6/07 .
Mad each condition listed on the reverside side of this form to see
the proposed activity can comply with the City's Haas Occupation
Regulations. $35.00 fee
TYPE OR PRINT IN INK
APPLICANT'S NAME S/L ✓be�A6� L 456A#1/CE 5 PHONE
PROPERTY OWNER /ICF PHONE
PROPERTY ADDRESS
'kB QIO/I/T (Street.) CA
(City) (State) (zip)
Type of residence (Single, Multiple, mobile home, etc.)_J/A/X-jWj
Type of business Ppa[ff rli✓ /SF['_u�iTYl
Brief description of how the business will operate CQAM99 2-1kG AX'
.S -EC UAiry C.0"AA//Es
Number of persons involved in bussiness,,��//�� /� l�ir)�� (1,,
List names of persons employed g2h /,I�,c,,�e,�10.
Square footage of usable rfloor area in
house (exclude garage) /.fOD
Location and square footage of area of
business activity in hone (example:
be 125 square feet) a /DA,
Description of macl
business operation
ry, equipment, and
valid p
CtTYOF LA OU1i A
FEB 19 1991
►lJ"%,%&&%FghYQ:
I have read and understand andaqlpee with the conditions by which a
home;ati n is allowed n tions on reverse side).
APPLIC 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 Hoene Occupation, or failure to comply with conditions listed on
reverse shall be grounds for revocation of permit.
• t • t t • t • • t t • f •
APPROVED Initials11 Date
Date
CONDITIONS ATTACHED-
DENIED Initials Date
LQHOMOCC.PRT 11111111111111111111
18