HomeMy WebLinkAboutCLE200800104 Legacy Document 2013-01-16d
Application for Zoning Clearance`
CLE #�
Check # 2 CO
❑Zoning ,Clearance '$35 Date: Q
" Receipt # . % _ Staff'.
REVIEW ALI 3 SHEETS -
PARCEL INFORMATION
Tax Map and Parcel: J�/LA 71, g PC Existing Zoning ' I'1(.V ,t GJ &M 11 P i
Parcel Owner: V( IZ. & us) / /A LA m i> � -�s;, � �
Parcel Address: Ll S PUMA? RI J f A -1, City�,l A 1 1`iT l E5 � >> Mate �� Ziw-y �
(include suite or floor)
PRIMARY CONTACT , /
Who should we all/write concerning this project? dlez U L VM i - i C�0 V I Qkt 1 M)A L -/%%lD CC
Address: 1 C tV�_ :N City (°,1-�l�121,Oi(2r��lUe- Zi�
Office Phone : # >> , Fax # Cq("Jto -,))51 E -mail 1.C. S Me-) 101/1 tb'.ltCi �sC
YLiA. �
APPLICANT INFORMATION
Business Name/Type:
Previous Business on i
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: vi : kl"I c
No s of 1 At Gi
*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 have 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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature MEW 6R ' �� Printed m 4Q-" -1
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 'public water?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies—
Is Is parcel on septic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will Kere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnino to complete the following:
Reviewer to complete the following:
Square footage of Use: 1 000
/N
ermitted as: _ C 5.'V1 1111x1 CL°
Under Section: _'�4 • Q - I - nLP
Supplementary reg ati ons section:
Parking formula:) Q
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Vi TN ns:
Y
t:
Proffe :
Y / `LI
If so, st:
V ' ce:
Y
ist:
SPIC-
Y/(If
If so, ist:
Cl ara e • fin,`
SDP's
O
Revised 04/28/08 Page 3 of 3