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111111 11111 1111 lt�i '
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"CITY OPLAOUINT
78-105 Call0-99tf1q*
P.O. BOX 1504¢
�. QulefejCA.92253
sea -1260:-
664-2246 PLANNING DIVISION 5/07
We -ad each condition listed on the reverside side of this form to see
the proposed activity can comply with the City's Hone Occupation
c
Regulations. $35.00 fee
TYPE OR PRINT IN INK
APPLICANT'S NAME e111141eZ—'S ,5—/y)4P9T PHONE • Z V 176,1'—
PROPERTY OWNER PHONE
PROPERTY ADDRESS 4-/0en /
(Street)
ty) (State)
Type of residence (Single, Multiple, mobile home, etc.) hlAV7-
Type of businessLOG•e�/'YJI o,el�
Brigf description of how the business will operate
Number of persons involved in business..//
• List names of persons employed N,,#
Square footage of usable f looz area in
house (exclude garage) �li� validation Stamp
Location and square footage of area of 05182 i 7131 p9-20-90 10
business activity in home (example: N CASH i TOTAL 1 35.00
bedrooms; 125 square feet)
Description of machinery, equipment, and suppli�}e -being used in the
business operationC�S/ii?lTi�/ TooLS L-cG
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 Applicit /ptheVthan property owner,'�,authorization of owner or agent
_
OWNER'- R IGNATURE ! 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.
t v APPROVED J Initials
CONDITIONS ATT HED
DENIED Initials
L0HOMOCC.PRT
D Date
Date'.