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03/2021 Owner Parcel # Mailing Address Permit # City Date Submitted State, Zip 60 Days Day Phone Fee Cell Phone Email Property Address Subdivision Twp Section______ Applicant Applicant Same as Owner Name Address 1 Address 2 City State, Zip Email Day Phone Clay County Planning & Zoning 3510 12th Avenue South, PO Box 280 Moorhead, MN 56561-0280 Tel (218) 299-5005 Application Fee: $50.00 Home Occupation Permit Application Administrative ---PAGE BREAK--- 03/2021 1. Describe the type of activity proposed to occur at the site: 2. How many square feet of floor space will be used for the activity: 3. Number of employees, other than yourself 4. Is activity of a temporary nature? ❑ Yes ❑ No 5. Describe the availability of parking for the proposed activity: 6. What will be the days and hours of operation for the proposed activity: To the best of my knowledge, I certify that the information provided on this application and accompanying documents is true and accurate. Applicant signature: Township Office Signature: