HomeMy WebLinkAboutCLE201300113 Legacy Document 2013-05-31Application for Zoning Clearance
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CLE # W3 3
OFFICE US O LY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff;
PARCEL INFORMATION
Tax Map and Parcel: [n I 0--s-06 A J Existing Zoning
Parcel Owner: 1 (Aho t -'Lk) V L= S I AA LOOT C 0 iu Pt kAA'i'
Parcel Address: �Y'c�w��7�� ?��` City ��� (oTL� sv;� State Zip
(include suite or floor) (At
PRIMARY CONTACT
Who should we call /write concerning this project? HIV \� c3'tti
p°i,
Address: I qs �J)-rtv e__ City ,YiAv1.� �s�, State L,//q Zips
�) Cell Fax h 31 t, 639 Office Phone: ( 7 —��g� C # �G ��S` d' 99((- --39/D E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership ✓(Change of use Change of name ✓ New business
Business Name /Type: COLT- vAsc�.k"
R1 1 l i
Intake to complete the following:
Y /®
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
f �,• ,mss
Square footage of Use: S � a�5 '2d>
0/N
ermitted as:,
Y /(S) -.-2.2 .
Will there be food preparation? Under Section:
If so, give applicant a Health Department form:
Zoning-review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water?
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 applies _
Is parcel on septic or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/9
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Parking formula:
Required spaces: /0
Y/N
Items to be verified in the field:
Inspector
Notes:
Date:
uvaa aaa w ..
Violations:
Y /IQ
If sct- 2St:
Proffers:
If so, 'Z ist:
Vari, nce:
Y/
If so, ist:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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