HomeMy WebLinkAboutCLE200900087 Legacy Document 2012-08-31Application for Zonin "Clearance`°
CLE # �� �- �T ''� ��
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PARCEL INFORMATION J r 4 r 6 i I
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Tax Map and Parcel: V Existing Zoning -
Parcel Owner: �7D d��'� � � � t!� L �G/T9V (���' ✓1 //V
Parcel Address: c/� JJJ ity C t1►L/'l- r Iat� Zip C2 G
(include suite or floor)
PRIMARY CONTACT R
Who should we call /write concerning this project? Kmm 7 +5 r eeV / L' t le.A )A
Address: p_�o,[ t75 City e— State
Office Phone: (2s aag• OS07 Cell # 7SI,976Z 7S Fax ,
#W' DM 17 E- mail ;A-Po@ 6; hetf, P.��NiQ, or�9
I APPLICANT INFORMATION I
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of
vehicles. and anv additional, information that you can pro
I
available,parking spaces, m mber of
*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 or ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the b t of my kno edge. I have read the conditions of approval, 2�tA understand them, and that I will abide by them.
C
Signature Printed
Intake to complete the following:
Is
Is u 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
Reviewer to complete the following: I Square footage of Use: VL C4
/N
-mitted as: 4t/l' eVW
Under Section:
Supplementary regulation section:
Circle the one that applies Parking formula: '1 ]
Is parcel on private well or public water? 1 ► U f� r If private well, provide Healt epartment form.
Zoning review can not gin until we receive approval from Health Required spaces:
Dept. FAX DA�
Circle the o that applies
Is parcel on sep ' ublic sewer?
Y/N
Will you be putting up a new sign
Sign permit.
Permit #
Y/N
Will there be any nKerPe
tr
If so, obtain the pro mit.
Pe rmit #
any kind? If so, obtain proper
or renovations?
7nninn to rmmnlatp the fnllnwina-
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3