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CITY' OF LACtor,
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P.O. Box..
. Ouin+eoCA-9225.
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664-2246 PLANNING DIVISION 6/07 .
ad 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 NAMEIEA�A / S PHONE 6i 9 NG -C> --a--
PROPERTY OWNER PHONE 0<13�p -
PROPERTY ADDRESS ? 377 SGi -A
Str*et•D
CA
(City) (State) (zip)
Type
of
residence
(Single, Multiple, mobile home,
etc.)
Type
of
business�J-
Brief description of how the business will operate Mi
to�s�s OF t,4!22— c,— MIF,
V .^ cz csrw c \ 0 LA At N ; �c�
Sk.pQjL- . "A(t L -Y OFF
persons 1nvolved in business _
List names of persons employed '��F-M r 0A?-,) 5
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JeD A;:i
Square footage of usable floor area in
house (exclude garage) a-700 validation Stamp
Location and square footage of area of 01018A�H9140T?'�-0�5-9i 35.U�0
business activity in home (example:
bedrooms; 125 square feet)
Description of machinery, equipment, and supplies being used in the
business operation C-, VAC-u"t S
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse side).
-D5,,k.�k �, ON -/-:)-/91
APPLICANT SIGNATURE DATE
If Applicant is other than property owner, authorization of owner or agent
required.
/A
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 5V Initials -(� Date
CONDITIONS ATTAC ED
DENIED initials Date
LQHOMOCC.PRT