HomeMy WebLinkAboutCLE200600273 Legacy Document 2015-01-21r `
A6 -�_-7
Application for
Zoning Clearance
' /ttc,NP
oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: � 100-66— -' 131A0 Existing Zoning:
Parcel Owner:
Parcel Address: J60'4 C12 -e Rd- City 01""10 i 11'x- State V a- ZipZZ?01
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): 4 �� : `� f� i AN S
Address ` 13 oY b / 6 2::,— _ City �GLi' / State V "� Zip
Daytime Phone rS '-� l DL I Fax # C__) E -mail
Business Name /Type: C>-NC� i f
Previous Business on this site:
Proposed use:
-1
P (r
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*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 owner's permission to use the space indicated on this application. I also certify that the information
provided is 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.
// 6 0 C
Signature of � Busin s Owner or Agent Date
�VI
Print Name
APPROVAL INFORMATION
[ ✓] Approved as proposed [ ] Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, xl 19.
] 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.
Building Official
Zoning Official
Other Official
Date I ( . e C.
Date u2 v p ,
Date
FOR OFFICE USE ONLY CLE # 7 6(No - 9 -7 3 _-7 v j ^�
Fee Amount $ 00 Date Paid l I- MP-01P By who? Receipt # to Ck# / `�' J By:
s t4
plicant LV �vl"F' tii�e . iviio i�,iii :
,J
Do you have one of the following?
❑ YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES ❑ NO
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and /or;
The square footage of each room or area of use;
Use of each room or area
If using less than the entire structure, note the location within the
structure.
: oning Tech to c
Violations:
❑ YES 0"'NO
If so, List:
Variance:
❑ YES ( NO
If so, List:
the following:
Intake to complete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES NO
Will there 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
❑ YES D N--O-
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
ES ❑ NO
Is on public water and sewer?
F�KE'S Fj N.OJ
Will you beTdting up a new sign of any kind? If so, obtain
proper Sign ermit.
Permit# F!5 Z6®4?_f,�Cj-
❑ YES []NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES (NO
If so, List:
SP's:
❑ YES E NO
If so, List:
5/1106 psnr. 1 nr4
e jr
A
„ewer to complete the following:
4uare footage of Use:
YES ❑NOS
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4