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,10. <br />11 <br />12 <br />13 <br />14 <br />15 <br />Please provide a brief description of how the business operates at this site (for example, <br />please describe the general nature of the business, what activities occur on-site, the ' <br />hours of pperation, open to the public). <br />5fu1. fl. chu"J { ^\Ylz'-= <br />ruo.H <br />Do you store equipment, materials, or products within the buildingZ Yes 0 <br />Will there be outdoor storage of equipment, materials, or products? Yes n <br />lf yes, please describe: <br />Will your business include a lobby or waiting area? Yes <br />lf yes, what will be the dimensions? <br />Do you manufacture a product at the site? Yes E No <br />lf yes, please describe: <br />*oX <br />*o E, <br />x'No <br />K <br />Do you plan on making any improvements to the bu!$jng such as: exterior painting, <br />signage, interior tenant improvements? Yes E *o F <br />lf yes, please describe: <br />Does the proposed use involve a patient care profession, such as doctor, dentist, <br />chiropractor, acupuncturist, or physical therapist? Yes f] *o K <br />ls the proposed use within the mental health profession, such as: <br />16. <br />cm\cntr-frm\C of O questionnaire <br />07t2012 <br />Ktr <br />No/Not Applicable ! Psychologist E Psychiatrist <br />Socialworker Other <br />ls counseling proposed as a part of your business operation? Yes E No <br />Does your counseling business contract work with a public agency? Yes E <br />lf yes, please describe: <br />Page 2 of 4