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HomeMy WebLinkAboutCLE200800129 Legacy Document 2013-01-17Application for Zoning Clearance CLE # Z00 �lRC;IN \P PARCEL INFORMATION Tax Map and Parcel: 614 6C; L °- o? — ®�J' ��✓� d ]� Existing Zoning 1, Parcel Owner: yC___ yn ( � �,t_�,.. O /�,L -rJZ_ ✓I Parcel Address: I 4/ Semi'rvo le TrLCity Cis y'1 I 1 e- State V/C7-. ZipZZ`IU (include suite or floor) PRIMARY CONTACT Who should we call / /write concerning this project? Address: City Office Phone: l� Cell # g44 # APPLICANT INFORMBfMN Business Name /Type: Previous Business on this site State - ZipZ� O E -mail - 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 permissibn 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 ved as proposed Intake to complete the following: Y /( VN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Yl N ill there 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 6 -/ /, '- Q q Circle the one that applies Is parcel on private well or,pl blic water? _ If private well, provide Health Department form. Zoning review can not begin until we r eive approval from Health Dept. FAX DATE Y) Circle the one that applies Is parcel on septic or public sewer? Y (N Will-yoTi e putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y / I� Wilr5ere be any new construction or renovations? If so, obtain the proper Permit. Permit # ZoninLy to complete the following: Reviewer to complete the following: Square footage of Use: Y/N n-/ Permitted as: i 04+Q v+ 1 t AMQol�( Under Section: d �• k �T• 3 "C1�9� Supplementary regul'atti¢ns section: I� Parking forma < Required spaces: `cvd (, vo k— g „c Y/N Items to be verified in the field: Inspector • Date: Notes: V' ations: N 7so, List: Proffers: Y If so, ist: Vari nce: YIfs / List: SP's: Y/© If so, List: $ackflow Device and/or Current Test Data Needed Contact ACSA 977 -4511 x 119 Clearances: SDP's r Revised 04/28/08 Page 3 of 3