HomeMy WebLinkAboutCLE201500042 Legacy Document 2015-03-24Intake to complete the following:
YOuLl,
Is HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
ill 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
Circle the one that applies
Is parcel on private well o publi�ent
e well provide Heal form.
If private ,
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that a plies /
Is parcel on septic 4E_public sewer?�
Y Wil (/
you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y ONWire be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: 2 yL)b
6/N
Permitted as: �.
Under Section:
Supplementary regulations section:
Parking formula: �
%oJD
Re'aoube
uirespaces:
Y
Item verified in the field:
Inspector : Date:
Notes:
Zoning to complete
Violations:
Y/
If so"fist:
the following:
Proffers:
Y/
If so, st:
Variance:
N
If so, List:
SP's: Q,Nli�
Y
If sost:
4
9,
Clearances:
5z
SDP's
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 1 �2 �� `� SW-, �`�y L Q _ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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
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].
I a --1) ,- P",tL4� J
Signatu of Applicant
Print Applicant Name
Date
I
P
1