HomeMy WebLinkAboutCLE200800169 Legacy Document 2013-02-19PRIMARY CONTACT
Who should we call /write concerning this project?
Address : ity CtM40 it /e�, WW tate Zip �+
Office Phone: ( �( � - yb Cell # Fax /
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APPLICANT INFORMATION
Business Name /Type: 1 olipLa �lJ i WE'- T lI nl Lid c4r R-) MC711 C—
Previous Business on this site
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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: % ' .7 U- /A A 6
*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 o ermission to use the space indicated on this application. I also certify that the information provided
is true and accuKgG_-tBthe bestAf my kKowledgd. I have read the conditions of approval, and I understand thein, and that I will abide by them.
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ROVAL INFORNIYTION
].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:
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Intake to complete the following:
Is //I1
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y // I�
Wil 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 wel or public wat ?
If private well, provide th ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or ublic s er?
Y/0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmlnlpfp the fnllnwina-
Reviewer to complete the following:
Square footage of Use:
0 / N
rmitted as: AA&S u�t l Gr /
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
�✓N
If so, List: � (�
Prof s:
Y/
If so,-List:
Vari We:
Y /Nl )
If so, ist:
SP's:
?iY N
If so, List:
4
V- F-i
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3