HomeMy WebLinkAboutCLE200800162 Legacy Document 2013-01-28l
Application for Zo ing Clearance_;
CLE # 6�
PARCEL INFORMATIO�.�
Tax Map and Parcel: / /�Tf /}' /Existing /Zoning
,y
Parcel Owner: ✓ ��(=s �/T� //U ���i` ���
Parcel Address: 2U 0 (j "� City 4/1CL State Zip �r?�
(include suite or floor)
PRIMARY CONTACT 1
Who should we call /write concerning this project? 1 1j2_
Address : �i `�I 1-1 s I �- City ��� State Zip 2_X C
2gC)9
Office Phone: A j- Cell # Fax # E -mail �C t�C h i V 3 \ �Ao t y
I APPLICANT INFORMATION
Business Name /Type: 04-NA- C>W R C S lA l L LS1
Previous Business on this site
NO N
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, anal any, additional information that you can provide: ?i e't o =2naLA.7 (c, E-i-C, (""AL-w1i l n- O
U C V i C vr c: A 'viC' - `C t2k 0 t o r_ 9 P l il11
*fihis Clearance will only be valid on t ie parcel for which it is al3proved. If you changb, intensify o love the use to a n wllocation, a new Zoning \l
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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature � i— Printed 1' —� I fV/i U (2 G S,-O L
u
[S/ 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:
T
Intake to complete the following:
N
use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
W 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 p �mte ?
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 appl' ,
Is parcel on septic o ublic ew r?
Y/N
Will you be pu 'ng up a new sign of any kind? If so, obtain proper
Sign permit.
Permit it
Y/N
Will there be ny new construction or renovations?
If so, obtain th proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 5o6
6
Y/N
Permitted as:
Under Section: cZ,17,4f
Supplementary regulations ection:
Parking formula: l %�
Required spaces:
Y/N
Items to be verified in the field:
Violations:
Y/N
If so, List:
Proffers:
Y/
If s , st:
Variance:
Y/N
If so, List:
Y
SPast:
If
Clearances:
SDP's V a
Revised 04/28/08 Page 3 of 3