HomeMy WebLinkAboutCLE200800186 Legacy Document 2013-02-19Y
Applicati ®n for Z® ing earance
CLE #
Parcel Address: S X19 Co R- --A-5 C �r::-1L– PC ' City CCU ��_F State
(include suite or floor)
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_ Zip'ZZ4'I 3 2
PRIMARY CONTACT
Who should we call /write concerning this project ?T1
Address: p' U' City &V1 L-t,-C-- State Zip'1. LIP Z-
Office Phone: (� �1� 1' � �yW Cell # 2S e 23 Fax # �T"d� ' S 1 `G�c E -mail �4 � � � ,`1 ` l� ��w' 11'e— 6' `�
I APPLICANT INFORMATION i
eA/"_4_
Business Name /Type: So\f S � LULLS C_L< U l-z, C' y C.-L-1 .N C- C HA-L� _ Cif( G -FF CO' Zb'
Previous Business on this site OL-D -RAIL- &—O -f-_ LL-;U r:>
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:-11,P_ s T 6nf� ' �� C'- c li•v1: C t�) � .z, X11 �tSc
C:l vl� us0_' ,� W L L. '�Cv�` v1�-�v V_ -8.'.0 w , J11 i_ • UC- 1' (A)v ,
� AULko q l 01� �'�.`•�1 S 1'U `t ? K ' t'�. i t._. Vt IrL. fi - LtlJ u- y 3
*This Clearance will only be valid on the parcel for which it is approved. If you change, int nsify or move the use to a new location, a new Zoning
Clearance will be req>:Yled.
I hereby certify that l wn 01' lave the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and acc rate �o ie best o gay knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �r' ( PrintedL1'- �F/if- I�
complete the following:
Is - Li LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / e
Will sere 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 %p bu lic ater?
If private well, provide ' alter h arrtment form.
Zoning review can not egin until we receive approval from Health
Dept. FAX DATE
Circle the one that aripa Kli Is p arcel on septic osew ?
Y/N //
Will you be p htting new sig n of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a iy new construction or renovations?
If so, obtain th proper Permit.
Permit #
7nning to comulete the followinLy:
Reviewer to complete th following:
Square footage of Use:
N
�
Permitted mitted as:
Under Section:
Supplementary regulations s ction:
Parking formula:
Required spaces:. � `_� _ p�►'`-�
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violdtio'ns:
If sd �L'st:
i
Prod
If s //6; List:
Variance:
Y%ff
If sb, L• t:
SP's:
Y/N
If so, List:
„ « 1
Clearances:
SDP's �a
Revised 04/28/08 Page 3 of 3