HomeMy WebLinkAboutCLE200900069 Legacy Document 2012-08-30r-
Application for Zoning Clearance
CLE # C3 - -r
OFFICE U ONLY
Zoning Clearance '$35 Check #: tDate,�
PLEASE.REVIE °W.ALL 3.' SHEET eceipt
PARCEL INFORMATION ` ��
Tax Map and Parcel: p % % . Existing Zoning
Parcel Owner: s 1 n-) 0 /NJ I�� )04 r FO / d
Z
Parcel Address: / (rJ�l� �) -P City (J) V D 11_D State V lJ�- Zip Z�!C
(include suite or floor) jl .n c- I 1 .— n i - rt_ - _ 4- e? l
PRIMARY CONTACT NQ'07C. Q A 'C. P �
,�.-
Who should we call /write concerning this project? ao DJ Ll JjT (7
Address : 1(/360 R1 o D City ��2't7 5v,)( f, State A Zip 20 ytt
Office Phone: (_) -Cell # qG� F E -mail
APPLICANT INFORMATION I
Business Name/Type: Y �� C� `°-� t\J 7 � �� / IV J
Previous Business on this site 4
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: % P /'YI0O /D c 1 � 0
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own r have the 's pe i ion to use the space indicated on this application. I also certify that the information provided
is true and accurate o th s w] d e'��hav read the conditions of approval, and I understand them, and that I will abide by them.
Signature L ` Printed 46
Intake to complete the following:
Y N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y�/N�
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign permit. 1 N •� e�-1 C1,6�
Permit #
Y/N
e be any new construction or renovations?
If so, obtain the proper ermit.
Permit #
r
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use: /1 , k u PJL
Permitted as: Gw
Under Section:
Supplementary regulations section: '
Parking formula:
V x' (.
.1 t/Ia W
J
Required spaces:
I -n) S �� �V. , VIA -,-W
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol • ns:
Y/N
If ist:
ProMs
Y
If s :
Vari e:
y
If o L'st:
SP
f t:
Y O'i
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3