Stemple•
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'CITY Of LA GUN
78-05 Calls tete!
P.O. Box 1304
Le OulefetCA.111
,(ate) $64 -1246
664-2246 PLANNING DIVISION 6/07
ad each condition listed on the reverside side of this orw to see
the proposed activity can comply with the City's Home Occupation
Regulations. $35.00 fee
TYPE OR PRINT IN INK
6j'
I
APPLICANT'S NAMEJ V Opt [C r/1 PHONE �o _-7 6b
PROPERTY OWNER o _ PHONE
PROPERTY ADDRESS / 1
�f- (Street)
A Kr�Vlat l -,?-
(City) (State) (Zip)
Type of residence
Type of business 't, a
tiple, mobile hone, etc.)
Brief description of how they business will operate �f� a/7�SC�4
v
Number of persons involved in business 922,9 ZC)U
List names of persons employed X nv�,�° �.
Square footage of usable floor are in
house (exclude garage) �e� Validation Stamp
Location and square footage of area of
business activity in home (example:
bedrooms; 125 square feet)
Description of machinery, equipment, and supplies being, sed i the
bussQess operatl,Qn Ch -c a we /
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.
APPROVED Initials
CONDITIONS ATTACHED
DENIED .-Initials
Date
Date
LQHOMOCC PRT
S