HomeMy WebLinkAboutCLE201300038 Legacy Document 2013-03-070
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Applicatibn for Zoning Clearance
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CLE 20� ��
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OFFICE T1
Date; 7.25 ` � �
ME ASE RD' VIE W ALL 3 SHEETS
Cheelc #
Receipt # _1-10 Staff: I i --
PARCEL INFOR TIO I l (j ReA
Tax Map and Parcel: I I " 3 v 1� +' Existing Zonin 1 li/1 ft>U'tW
Ma ew '
Parcel Owner;. t—Irb=a
Parcel Address: o —City mm State Zip��
(include Ute or floor)
PRIMARY CONTACT ,
Who should we call/write concerniin/g this project?
Address ; p2tJ %�15/2��71�Y° �. City 0 State ZipGTl�
Office Phone: (!� • 3 cell #?/?
APPLICANT INFORMATION '
Check any that apply: Change of ownership Change of use Change of name Y�*%v business
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Business Name/Type:
,Previous Business on this site
Describe the proposed business including use, number of employees number of sbifts, available parking spaces, n mber of
vehicles, and any ndditlonal information that you can provide;
*This Clearance will oply 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 perinission to use the space indicated on this application. I also certify that the information provided
is true and accurate to: a best of my U wledg , I have ad the conditions of approval, and I understand them, and that I will abide by them.
1MR r
Signature Printed
AP�RO�AL INFORMATION
['Approved as proposed [ ]Approved with conditions [ ]Denied
[ ] Backpow prevention device and /or current test data needed for this site. Contact ACSA, 977.4511, xl17.
[ ] 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,
Motes:
Building Official Date
Zoning official Y71 A Date
Other Official Date
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'A AM e 1 t e, A 9 of 4) 296 -5832 Fax; (434) 972 -412G
Revised 711 /2011 Page 2 of 3
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Intake to complete the following:
Y N
Is u 'n LI, HI or PDIP zoning? If so, give applicant a Certified
gineer's Report (CER) packet.
Y N lAJ 1 Ul
ill there be food pr
If s o, give applicant a Health Department form. v
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o p blic wate
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Its parcel on septic o public sew ?
Y) N
Will you be putting up a new sign of any kind?
Sign permiJi'�
Permit #
If so, obtain proper
Y /J N
l there be any new construction or renovations?
If so, obtain tie roper Permi
p W"
Permit # t
2 1612 -AL
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
6/N
Permitted as: ;P&
Under Section: Li1� 11 A ce . C. U ��
Supplementary regulations section:
Parking formula: rf 5
d
Required spaces:
Z7
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol *
Y/
If so, ist:
Proffers:
1' /N
If so, List:
Variance:
v /N
If so, List:
's:
"' /N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application;
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner dentified below:
the owner of record of Tax Map
delivering a copy of the application in the
Hand delivering a copy of the application to k v-L
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].