HomeMy WebLinkAboutCLE200800106 Legacy Document 2013-01-16Application for Zoning Clearance ��°
CLE # 200 ? - I6 "ry - `
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❑ "Zoning CI
PARCEL INFORMATION
Tax Map and Parcel: 64-6 66 66 b b Cog Li
Parcel Owner:
Parcel Address: ef City
(include sufW or floor)
Existing Zoning /46
t0a(
State
Zip
PRIMARY CONTACT �. �c
Who should we call --/write concerning this project? 1 ^ �/
Address : �, V. �()1L �� City r t� f� Uf Imitate �� H" Zip oC a�
Office Phone: ►l M r2 a.O- 9145ce11 # Fax # mail jtr,,- � 6l 16 (LiA ( .x.00
APPLICANT INFORMATION
Check.any'that' '01' : Change of3oygsne�sh //ip '; Ch�nge;;ofuse" = =Change of`ria`me New =business -lo Business Name /Type: 6 i \ eko
Previous Business on this site o,- a
Describe the proposed business including use, number of employees, umber of s ifts, available parking spac s, number
Qf-
vehicles, and any additional information that you can provide: - C�1Y17� �%' -Pb r T " R!?�1 Z3 —
*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 infonnation provided
is true and accurate to the best of rny knowle ge. I have read t conditions pf approval, and I understand them, and that I will abide by them.
v
Signature i nted
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PROVAL INFORMATION
Approved as 'proposed
6 e,
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Intake to complete the following:
Y / 1P
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wilt re 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 bli w ter?
If private well, provide Health epartment 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 lI
Y/N
Will you be p ttin up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a y new construction or renovations?
If so, obtain th proper Permit.
Permit #
Zonings to complete the followine:
Reviewer to complete the ollowing:
Square footage of Use: 4
Q:tted as: � ahb_
Under Section: 6k
Supplementary regulatio s section:
h-
Parking formula:
Required spaces:
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
'
J
Revised 04/28/08 Page 3 of 3