CLEEK0
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IIIIII 11111 II�� ���i
'CITY OF LA OWN
Ta-105 C9II9 E8t616
P.O. BOX 1504
t
QvInh;CA.Otte
(got) see -1246
664-2246PLANNING DIVISION s/07
Sad each condition listed on the reverside side of this form 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 PHONE SUQ
PROPERTY OWNER PHONE
PROPERTY ADDRESS
(Street)
1 .- r_�, ,,, O A
(City) (State) (Zip)
Type of residence (Single, Multiple, mobile home, etc.) �I(y"6
Type of business a0V\C_-P A-e
Brief description of how/ the businesswill operate _
(AraA,n l Okn S 1te _ 6t l�i nn OA A Zt�hx Ache i
Number of persons involved in business A
List names of persons empl a�
;41.4L
Square footage -of usable floor area in
house (exclude garage) ) a (ay, & 4- - Va d i St
U 0051��' �� %J! �-i3-89 i0
Location and square footage of area of 10 CASH i TOTAL 1 35.00
business activity in home (example:
bedrooms; 25 square feet)
n±� SB, 1-m Q i!4 _';�e--
Description of machery, equipment, and supplies being used in the
business operation 1e ���stiP i�nr�rQQ.L .mac
I hay tad and under [and and agree with the conditions by which a
hanig occypat4on_ awed (Conditions on reverse side).
-I-_:� `.-��
DATE
If Applicant is other than property owner, authorisation 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 6 _/9-ff Date
CONDITIONS A HED
DENIED .-Initials Date
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