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HOME OCCUPATION QUESTIONNAIRE

Applicant Name:
Business Name:
Address:

1. Describe type of business you propose to conduct:

2. Will this business be conducted entirely within your residence as it relates to activity at your residence? Yes No

3. Will there be any employees other than members of your immediate household? Yes No.
If so, describe:

4. Is the dwelling used mainly as your family residence? Yes No

5. How many vehicles are used in conjunction with the business?

6. Will anything be made on the premises? Yes No.
If so, describe what and how it will be made:

7. What equipment and machines are used in the business?

8. Will anything be stored on the premises? Yes No.
If so, what and where (If in car, van, truck, so state):

9. Will there be any materials, goods, supplies delivered to the residence? Yes No.
If so, state how and frequency:

10. Will any customers or clients come to your home? Yes No.
If so how many per day?

11. How is contact made with customer or client?

12. Will any items be sold on the premises? Yes No.
If so, describe:

13. Will any other locations be used in conjunction with this business? Yes No.
If so, describe:

14. If product is sold or distributed, how is it delivered to the customer?

15. Is outside signage planned? Yes No.

16. Is customer parking planned (other than named residents) ? Yes No.

FOR APPLICANT: In signing this document, I state that I have received, read and understand the "Ordinance for a home occupation" and that I will abide by all such regulations. I realize that a violation of these items justification for revoking my licenses and prosecution for a zoning violation.

Signature of Applicant_________________________________________________ Date

Please Fill Out and Return To:
License Clerk
City of West Plains
1910 Holiday Lane
P. O. Box 710
West Plains, MO 65775