HomeMy WebLinkAboutCLE200800130 Legacy Document 2013-01-17Application for Zoning Clearance =�` °;8
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CLE # Z 00 -q - /3 Q � ?-�`
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PARCEL INFORMATION ,/
Tax Map and Parcel: G' (> l /� ' d O - 00 `` �b U 0 Existing Zoning /�I ��c✓��y - Cur��i�,�•a /
Parcel Owner: P70111'`G elle / ,c✓�✓
Parcel Address:-306'0 �e f/17�t � City C-1411111 (I rIl", State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this projje'c``t?
3oeo ,3",- X;)m,- ,(doe 9Y�,, e G,r :r��)WIl� State 1*�%� Zi
Address: "ty p
Office Phone: L� Cell # ��'� %ld'� °� Fax # E -mail
I APPLICANT INFORMATION
Business Name /Type: �
JF
Previous Business on this site C OMLnon
Describe the proposed business including use, number of employees, number of shifts, available p rking spaces, number of
vehi�l� , and any additional information that you can provide: / e2L1 S__ A
roc LISz e/14/
*This Clearance will only be valid on the parcel for which it is approved. If yoiMhange, intensify or mdvd the usb to a new location, a new Zoning
Clearance will be required. 11 R eo �e r m a,-Y-)
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and ac-c-urat�e to flee best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature :; , /U Printed / / a / ✓0 7he�
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Intake to complete the following:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�
Will 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
Circle the one that applies
Is parcel on private well or blic water?
If private well, provide 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 se ' or public sewer?
/' /e� �� ill yot(�pt�rttra new sign of any kind? If so, obtain proper
Sign permit. PO
Permit #
Y /0-
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: D�
/ N
mitted as(f
Under Section: i -�• ( (fY
Supplementary regulations pection:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ons:
If sd, List:
Proffers:
Y/
If sq List:
Variance:
Y /�N
If `st:
SP's:
V-S jo ust:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3