HomeMy WebLinkAboutCLE201400069 Legacy Document 2014-05-02Application for Zoning Clearance
CLE # R61 q— K f
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PLEASE REVIEW ALL 3 SHEETS
OFrrCL USE ONLY
Check# 65 Date: L -al- W
Receipt # _ Staff: �'(�
PARCEL INFORMATION -)3
Tax Neap Parcel:
and Existing Zoning - -�
Parcel Owner: 10 4 50Ct1ak k �1�1�i�di Pfti��' y 6: o� / / /��
/
Parcel Address: —J 6 1 6'0 C6 6-A, City G�v�1r> t7i� _,State `�� ZiP221
(include suite or floor)
PRIMARY CONTACT
Who should we /write
call concerning this project?
q� ,I
Address:, QO QXX, S\ City, C VUI State U Zip o a CSj
Office Phone: 3U1 z%P 7 S Cell # (,6Ss�O�Fax# �pJtR )\E-Mail VC.`tC fpr, a� r
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change off name. . New business
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Business Name/Type; 1�tC�� --� G�� f%`� /" V '> U`''Pi z), " b
Previous Business on this site. rLC 7�i �7'% 7C� IJUfl�i�
Describethe proposed business including use, number of employees, number of shifts,,;aYailable parking spaces, number of
vehicles, and any additional information . that you Panprovide:
*This. Clearance will only be valid on the parcel for which it is approved. If you change, intense or'move'the vse to >a new location, a new Zoning'
fT
..Clearance will be required: . . .
I hereby certify that Lown or have the owner's permission,to use the space indicated on this application. I also certify that the, information provided
Js true and accurate to the best of my'knowledge. I have,read the conditions of approval, and I understand them,; and.that:I will abide by them.
Signature !cy P d
APPROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacltflow prevention device and/or,currenttest data needed for this site. Contact ACSA, 977 -4511, x117.
No physical site inspection has been, done for, this clearance. Therefore; if is.uot a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date. _
Notes:
Building Official Date
Zoning Official hate
Other Official Date.
Intake to complete the following:
Y /
Is use LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will Mere 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 or �i b ►c ter?
If private well, provide Health ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie `'
Is parcel on septic or publ se er?
N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit �r N�
Y /
Will t re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
l N yp �V
rmitted as: .7 Qi� �'-
Under Section: T �}
Supplementary regulations section:
Parking formula:
Required spaces: -�qAt /
Y/N
Items to be verified in the field:
Inspector :
Notes:
Date:
viol tions:
Y A
If so, List:
Proff rs:
Y /V
If so, List:
v riance:
/ N
If so, List:
�9 79 3v
SP's-
Y/(�:
If so, List:
Clearances:
SDP's g
22)
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,
[County application name and number]
was provided to �`;v� ��t> ! ' (fit -OJ P the owner of record of Tax Map
[name(s) of the record owners -bf the parcel]
and Parcel Number 0 41 — 13 a by delivering a copy of the application in the
manner identified below:
Hand delivering 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
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 6 -0?-1 to the following address:
Date
[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].
Signature of licant
Print A plidnt Name
211Iq
Date