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<br /> <br />CITY OF SAN LEANDRO POLICE DEPARTMENT <br />835 East 14th Street, San Leandro, Califomia 94577 <br />(510) 577-3468 or 577-3392 <br />MASSAGE AND ACUPUNCTURE PERMIT APPLICATION <br />This is an application - NOT A PERMIT <br /> <br />Permit Fee <br />$ <br />Establishment Permit $100.00 <br />Masseur/Masseuse/Acupuncturist <br />Permit $25.00 <br />L1vescanlBackground $32.00 each <br />PO Admin Fee $25.00 each <br /> <br /> <br />Submit two (2) identical and current passport size color photographs showing <br />Submit copy of Driver's License or Identification Card. <br />Submit copy of diploma or certificate of graduation from a recognized massage school (for masseur or masseuse application <br />only) <br />5. Pay all applicable fees to the San Leandro Finance Department, 835 E. 14th Street, Cashier's Office. <br />6. Schedule an appointment for livescan/background at the Police Department - Call (510) 577-3279. <br />7. At the time of your livescan appointment, submit your application and receipts to the Police Department. <br /> <br />This application is for (please check the appropriate box) <br />o MASSAGE OR ACUPUNCTURE ESTABLISHMENT <br /> <br />o MASSEUR, MASSEUSE OR ACUPUNCTURIST <br /> <br />Applicant's <br />Last Name <br /> <br />First <br /> <br />Middle <br /> <br />Home Address <br /> <br />City, State, Zip <br /> <br />Previous Address <br /> <br />Previous Address <br /> <br />Home Phone No. <br /> <br />CellI Pager No. <br /> <br />Email Address <br /> <br />o Male 0 Female Date of Birth <br /> <br />Age _ Driver License No. <br /> <br />Exp Date <br /> <br />Height <br /> <br />Weight <br /> <br />Eye Color <br /> <br />Hair Color <br /> <br />Social Security No. <br /> <br />Scars, tattoos or other distinguishing marks? <br /> <br /> <br />Approximate Date <br /> <br />Police Agency <br /> <br />Nature of Offense and Punishment or Penalty Assessed <br /> <br />1. Name and address of Massage, Acupuncture or Business Establishment <br /> <br />2. Nature of massage or acupuncture to be administered <br /> <br />3. List all jobs you have had during the last three years (job duties, address and phone number of employer): <br />