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CITY OFLAaww
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K0191664-1146-
46
0191•s4-t:4s-
46 PLANNING DIVISION
ad each condition listed on the reverside side of this torm 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 g O h a A. Alien
PHONE
PROPERTY OWNER PHONE
PROPERTY ADDRESS - w r e 5 � Qi"i vr.�
,I (St et p
u1KT4.. ct%i �brV,Aq, /2�S
ty) (State) lZiol
Type of residence (Single, Multiple, mobile home, etc.) C"/%J /0—
Type of business l2l0.h+ Care — O FC-'Prew%ses
B ief description o how the byysiness will operate Prov; C11- C4f i
car 1 CL K* Q t -n !g dia to a1 &Lqd C o ym m a c ,•
Sect o r 1211002a x1 a 0 r'
Number of persons involved in business 1.
List names of persons employed k7Uy) P
Square footage of usable floor are in n
house (exclude garage) /, 3 �� sq. t Y. validation Stamp
Location and square footage of area of
business activity in home (example: 005182 10 9912 02-06-91 i0:
dr ; 125 square feet) 10 CASH i TOTAL 1 35.00
Description of machinery, eq ipment, and supplies being used in th
bugin �s pperation CDY» P u e r I�h�� t!q X �k �p re a.H (^ice
CL W O D 15 , w a' ., a c� N c. o ok
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse side).
APELICANT SIGNATURE DATE
If Applicant is other than property owner, authorisation of owner or agent
re i ed.
M4S -� —
I-/— q1
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.
V APPROVED Initials
CONDITIONS ATTACHED
iL
DENIED Initials
LQHOWXC.PRT
`c% Date
Date
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