HomeMy WebLinkAboutCLE200800120 Legacy Document 2013-01-17Y 1
Parcel Address: • 1�� �
�OT, ^ %� V —19 City (.; fU ILL rJ State Zip
(include suite or floor)
PRIMARY CONTACT I
Who should we call /write concerning this project? - ` l v
Address : 21-7 O S �`� -3 f—W D v— b� c,'TCity (' ��1 0 State ii% 'J 7— Zip
X733
Office Phone: � '1"7q '7/ 0 i) Cell # 313 uq C' Fax # — E -mail G' (� /Zf ' r r•� �. G7J�i�
APPLICANT INFORMA
Business Name /Type:
Previous Business on this site
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:
*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 accuptte to, the,pest of my knowledge,. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
ved as proposed
[-j'No physical site inspection has been done fo'
site plan.
[ ]
This site complies with the site plan as of thi
Notes:
Building Official
('a"77.
Intake to complete the following:
Y/
Is us I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /ilf
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 H ltli 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)
Will ' o be pu ing up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /NN
Will there be an new construction or renovations?
If so, obtain the p oper Permit.
Permit #
Zoning to comDleie the following:
Reviewer to complete the following:
Square footage of Use: / 2-- DU =�
YI / N
ermitted as: f
Under Section: lY. ' (d 99 ` a It
Supplementary rgguu ations section:
Parking formula
Required spaces�',_ , , A A 1—a 1
Y/N
Items to be verified in
Inspector : Date:
ILLS � li�l1.�.
A4 A 11A A !
Violations:
Y/
If s , ist:
Proffer
Y/
If s ist:
Vari ce:
Y /
If so ist:
SP's -
Y
If so, ist:
Clearances:
SDP's
91'b a-
vVYV-
Revised 04/28/08 Page 3 of 3