HAYNESHOME
• 1 I I'llll I'lll IIII II'I
79
OCCUPATION PERMIT
APPLICATION
"CITY OF LA QLQNTA
're -W Call* Es/e0•
P.O. BOX 1504 1
0 OusntaltA. $2203
k, -(61f) $64-1146
564-2246 PLANNING DIVISION 6/87
Read each condition listed on the reverside side of this form to see if
the propose C_t� can comply with the City's Home Occupation
Regulation .$35.00
TYPE OR PRINT IN INK /
APPLICANT'S NAME R�QN42 PHONE ��� L110"
PROPERTY OWNER F,"F PHONE
PROPERTY ADDRESS 4.109 Vi5rL6 5C_0 PIA, 6,0x 11
(Street)
(City) (State) (Zip)
Type of residence (Single, Multiple, mobile home, /etc.) 51AI(a
Type of business 0-on4NI�°!r(. &
Brief d scr.pt'op of how the business wil operate C v
-Awl
�-
Number of persons involved in business
• List names of persons employed
O
Square footage of usable floor area in
house (exclude garage) :7-,< Validation Stamp
Location and square footage of area of
business activity in home (example: 005i02 .0 8691 02-03•-86 i0
bedrooms; 125 square feet) 10 CA. 1-1 J. T0TA1... J. 35.00
Description of machinery, equipment, and supplies being used in the
business operation (�A�' e -4,-, A:C. Sh U.vT�S, 6AO UWS
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 6SE ONLY * / ' t • •
APPROVED a7,j Initials �1 v Date
CONDITIONS ATTACHED
DENIED Initials Date
LQHOMOCC.PRT