HomeMy WebLinkAboutCLE200800148 Legacy Document 2013-01-17Application for Zoning Clearance
CLE # X669 ° H S
PARCEL INFORMATION ��
Tax Map and Parcel: b G o9 1 no ����y ` 13 �. A0 (Existing Zoning .5
l 0
Parcel Owner: 6CzJR "el , P %Su VCc, �t� � F 11 k6cicl5
Parcel Address: 1600 cIU ��_S G- City 6, ko_HQ4Af-�Ui Qt0a_t_e (A Zip
(include suite or floor)
PRIMARY CONTACT ;
Who should we call /write concerni this pro,.ect? 4& i
'Address: - ,� A City _ h� j f16; /'� State _
S
Office Phone: Cell #4� Fax # v V',� E -mail _
Zip 2 A 9$
APPLICANT INFORMATION I
Business Name /Type: St' -e--`e d ('
Business on this
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 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 Printed IVVY) O00
[ ] Backflow prevention device and /or current test data neededfor this site. Contact ACSA ' 977- 4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore,; it is not "a determination of compliance with the existing
site plan.
[ ]
This site complies with the site plan as of this date.
Notes:
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Wil nth 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 CU �wlter?
If private well, provide Healartment 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 p U lic sew r?
Y
Wi]] you b-e-p tting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If s t e pro er Pe
Permit
Zoning to complete the following:
Reviewer to complete th following:
Square footage of Use:
/N , [
� rmitted as: `%C�kGt ( 44
Under Section: t
Supplementary regulptilpnss section:
Parking formulV� Q
Required spaces: w6q
Y/N
Items to be veri ied in the field:
Viola. 'ons:
Y/f)
If so, ist:
Prof
Y/
If so, List:
Varia ce:
Y ,
If so, ist:
SP'
Y l
If so, List:
Clearances:
SDP's
1
Revised 04/28/08 Page 3 of 3