HomeMy WebLinkAboutMinor Home Occupation (6) HOME OCCUPATION FORM
Minor ZEO Approval Date ! �I�2s ASSESSOR'S USE ONLY: I
SaIOr PZC Approval Date
PP Home Occupation Tape
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Expiration Date Code
Name r(-'tr('C i' &) c
Address of proposed occupation: / C A L� Y L Il
Telephone �-L o 2 v g D Zone
Description of Occupation:
2 S y r C1 j
Please use the boxes or an attached sheet to provide the following: A_ PROIFOSED SIGN
1. Attach copy of plot plan if appucable.
2. Use box A (or attach sketch)to draw proposed signage .
3. Use box B (or attach sketch) to draw the floor plan of the home
occupation area. IV
�
4. Architectural elevations for any proposed additions or modifications
must be provided.
B. FLOOR PLAN (_Basement 1st Floor 2nd Floor)
Floor area of dwelling
Floor area of home occupation
% of floor area
I
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Vave read the regulations regarding home occupations and intend to comply with said regulations. I
aerstanci i must notify the Planning Department in writing upon termination of ,his occupation at this
address. -
Signature of :applicant
Date
i�nat a :fs��er Date
s`0 Yellow = AE)oiic; t Pink = Street :ii
State of C
s�TVA Department of Public Health PAN
In Accordance with Connecticut General Statutes 19a-87b to19a-87e inclusive,
the Department of Public Health issues this license,which is non-transferable,to:
PATRICIA J JURGELAS
to operate a
FAMILY DAY CARE HOME
at
99 CHAPEL ROAD
SOUTH WINDSOR CT 06074
License Number: 52936 Regular Maximum Capacity: 6
Expiration Date: 11/30/2004 *Before/After School Maximum Capacity 3
The capacity is limited to 2 children under two years of age, unless an approved Assistant is present with the Provider or with the Approved Substitute.
*The before/after school capacity is valid during the school year only
Aw
410 Capitol Avenue, P.O. Box 340308,Hartford, CT 06134-0308 ((
Telephones: 1-800-282-6063, 1-800-439-0437 Joxel Garcia, M.D., Commissioner