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C I T Y O F M O D E S T O APPLICATION FOR HOME BUSINESS PERMIT AND AGREEMENT Planning Division/C & EDD PLEASE PRINT OR TYPE SEE REVERSE SIDE FOR RULES PERTAINING TO HOME BUSINESSES TO BE RETURNED TO BUSINESS LICENSE DIVISION WITH CITY LICENSE APPLICATION NAME OF BUSINESS: NAME OF APPLICANT: BUSINESS ADDRESS: PHONE: ( ) - ADDRESS: ZIP CODE: PHONE: ( - ) MAILING ADDRESS IF DIFFERENT FROM ABOVE: BETWEEN (cross streets): AND DESCRIPTION OF PROPOSED HOME BUSINESS AND TYPE OF ACTIVITIES: SALES and/or SERVICES CONDUCTED (check all that apply): ON THE PREMISES AWAY FROM PREMISES HOURS OF OPERATION: DAYS OF OPERATION: AVERAGE NUMBER OF PERSONS VISITING DWELLING (for business purposes): PER DAY PER WEEK LARGE FAMILY DAY CARE: CHILDREN PER DAY PER WEEK STATE ALLOWS UNDER COTTAGE FOODS OPERATIONS ONE FULL-TIME EQUIVALENT EMPLOYEE (not including family members or household members) HOW MANY TIMES: PER WEEK I DECLARE UNDER PENALTY OF PERJURY THAT I HAVE READ THE RULES AND LIMITATIONS ON THE REVERSE SIDE OF THE APPLICATION AND BY MY SIGNATURE BELOW I HEREBY AGREE TO ABIDE BY ALL RULES AND LIMITATIONS SIGNATURE NAME (type or print clearly) _ HOME ADDRESS: DATE FOR OFFICE USE ONLY: Account Number: Original Date Approved: Approved By: NOTE: IF WE RECEIVE A COMPLAINT ABOUT THE OPERATION OF THE BUSINESS, IT IS OUR DUTY TO INVESTIGATE SO THAT WE CAN VERIFY THE FACTS AND HELP TO MAKE CORRECTIONS OR ADJUSTMENTS SO THAT THE PROBLEMS CAN BE SOLVED. OUR DESIRE IS TO HELP BOTH THE COMPLAINTANT AND THE LICENSEE. IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE ZONING INSPECTOR AT 577-5279. MAIL THE TOP TWO COPIES TO THE CITY OF MODESTO, PO BOX 3442, MODESTO, CA 95353. SIGN