HomeMy WebLinkAboutCLE201400165 Legacy Document 2014-09-10Application for Zoning Clearance
CLE # Z O _/G
a_l
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Ca }% Date:
Receipt # Q f.q o 3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: Wi W (, --Q1 • — ()QSC () Existing Zoning 0,1 .ri — :A0JQa,
Parcel Owner: L-a< Ifr U—c-
—ewo
Parcel Address:. t+ Ly-&(l or I rr AA;) N City State �) A. zip
(include suite or floor)
PRIMARY CONTACT 1
Who should we call /write concerning this project? MUSt MU k%rt CA r
Address: N05 i'�i�of— R)'dgP C-e City ChC1r10ft0V4- State V% zipZ290)
Office Phone: (_� Cell #9C) 9.24' '047Fax # E -mail
yl1c� �
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: '2n 'l too!' / Mec� ti i C' r" ►U n� n yC°,MC y S'�o f i
Intake to complete the following:
YOLI, Is HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 pu lie water?
If private well, provide Health ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
is parcel on septic or, blic sewer?
Y/ N WIV r� kylc V. CTC S
Will you be putting up a new sign of any kind? f so, tain proper
Sign permit.
Permit _ 'Q�:. `�In B �4 �
Y/N V--,A �
Will there ben new construction or renovations?
If so, obtain t e proper Permit.
Permit #
7nninn Mon n1g%+A the inlinwina-
Reviewer to complete the following:
Square footage of Use: .3i *2-0
Y/N
ermitted as:
Under Section:
Supplementary regulations section: o
Parking formula: ; i G
Required spaces: 11 „ `'
Y/
Inspector
Notes:
verified in the field:
Date:
Viol ••'ons:
Y N
If s ` lst:
Proffers:
YjN
If sb,_L_ist:
Variance:
Y/N
If so, List:
s:
CY2,; N
o, List:
I
�
Clearances: ,.
SDP's
Revised 7/1/2011 Page 3 of
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
the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number O 61 W O — C) i — U A C) o oby 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 S ) -L �
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].
,RiFa—ture of Applicant
VAu,s�t-4,, la\
Print Applicant Name
,91 -Z6111
Date
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