HomeMy WebLinkAboutCLE201300020 Legacy Document 2013-03-15•
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Application fol Zoning Clearance
0
PLEASE
OFFICE u
Check #
.REVIENALL,3 SHEETS
� Date:
Receipt # Staff:
PARCEL INFORMATION U I r'�
Tax Map Parcel: Qli2i� �, f
and cmza Existing Zoning t- may c;rr� �Jb: ,a65 4 dal;
Parcel Owner: I�DeQAL ` 7T\OQ %rl.`b
Parcel Address: 562 �At,h th \Oor1 to,) r "'T City _ �►�� o ((r�h�ti�1�� State Zi 2°1 y;r p M
a;n:a D
(inc de suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ?hLI M1rr<1c�e.,a
Address. `• b0 L-,s Georg C31Jo. City State(:�)f5or :: A Zip
Office Phone: &.0 to $997 " Cell # 91a .516.399 , Fax # 111.91O . W3 E -mail OAT ivy (0311 C o tom.
APPLICANT INFORMATION'
Check any that apply: Change, of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site toles -,
Describe the proposed business �`cluding use, number of employees, number of shifts, available' parking spaces, number of
vehicles, and any additional information that you can provide: i?t�
*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 er's permission'to use the space indicated on this application. .1 also certify that the information provided
is true and accurate to the best of my' loo ledge: I have read the conditians of approval, and I understapd ihem,.ai\\�d that I will abide by them:
Signature Printed%'ty
APPROVAL INFORMATION;\,
Approved as proposed [ ]Approved with' conditions �[ ,] Deiaied
[ ] Backflow prevention device and /or current test data needed for this site. '.Contact ACSA,.977 -451 1, xl 17.
[ ] 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
Building Official Date �k` C
Zoning Official Date
Other Official Date
L
Int a to complete the following:
Y N
Is e ' LI, HI or PDIP zoning? If so, give applicant a Certified
En 'peer's Report (CER) packet.
Y -N
Will 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 well.o 4unti c water
If private well, provide He De ent form.
Zoning review can not begwAteceive appro val from Health
Dept. FAX DATE
i
Rei,iewer to complete the following:
Square footage of Use: jq q5
()/ N l
Permitted as:
Under Section: 25 • Z .
Supplementary regulations section:
Parking formula:
Required spaces;
Y t•
Circle the one that ap es
Items to be verified in the field:
Is parcel on septic r.public sewer?
Y/N
Will you be ping up a new sign of any kind? Ifso, obtain proper
Sign permit.
Permit # ,
Inspector
Y N
Notes':
l there be any new construction or renovations?
If so, obtain a ro r Permit
Permit # �-
i
l
Boning to complete the follo -vin
Violations:
Proffers:
Y
If so, .List;
If so; List:
Variance:
S 's:
/N
/N,
If so, List:
so, List:
'7z
'K,
92-
Clearances:
SDP's
2012-��
--11"115,
�/= A -7
e
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CEI*,TIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinationsi or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
i
I certify that notice of the application,
[Coudy application name and number]
was provided to �rozrtt%-. [$�,L�� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel plumber X_ by delivering a copy of the application in the
manner identified below:
Hand delivering :a copy of theapplication to,
(` [Name of the record owner if the record owner is a
person; if the owner of recordis an entity, identify, the recipient of the record and ilie recipi:ent's
title or office for that entity]
on
Date
Mailing a copy of the application to�oa,�Gq�
[Name of the record owner if the record owner is a pe. son;
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 3 `Z °13
\ � to4he f6l7owing'addresss.
Date
11 �' EMM�. ��re�� �r� ��.�.4b- c•t�s:� \e. ��'�' 22gC,
[address; written notice mailed to the.owner at the last known address o the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement], t
3
Signature of Applicant
`1J+�LCc C • Ct-br3
Print Applicant Name
Date
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