HomeMy WebLinkAboutCLE201500058 Application 2015-04-07Application f®r Zoning Clearance
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PLE ASE REVIEW ALL .3 SHE ETS
Receipt W 9 Strafe;
RMATION
Existing Zoning
Tax Mnp and Parcel: -0-6,
Parcel Owner: c (A
Zip
City
(include suite or floor)
PRIMARY CONTACT
Who should wecallilvrit0collcel-fiii.Igthis project?
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Address:
WficetFlione;nS Fax.4
AP LICANTW�ORMATION
�2.nge,0r,.,oWaergIIjp, change of we :Change; of name '4"" New business
c1le& RIWthat. ripply: Clia
buiinessNininelType:
Trevious'Business'on this site
6 ' d 9spHqcsJ number
of:employeos,-numor f._sljIfts,.�of
b
the. proposed � busin essIn rJu ding us6,41ulnbel' :avaIlqbleparl4
.Describe
d ditional info rina tio,11 tluttyo.0 cora provide: .
ad
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will only be valitin o -parcel for which itis roved; Iryou change, intensify or iiio,Ve:tllo,usoltp anew location, a, neNVzoliing
zthe
his Clearancethe
C learaner will be required.
Thereby certify that'd olvn or Have the owner s permission>to •usethe space indicated on this application.. IuISO certify drat the information,provided_
n ru
best knowledge. I havc�.read the conditions of approval, .and,l u st 11di tile Arid thitl will abide ::by thein.
isIftie tui& accurate the of my
Winted
Signature,
-APPROVAL INFORMATION:
i�etii ed
Approve Approved with conditions 8AS proposed
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Backti idn&�Iciiaaftr current test Contact kCSA,
There rnin tion of compliance mith the existing
done'llarthis ,clearance. ral-a, it is nott.deter a
icafsitci6spectlonhnsbq n
ys e
site plan.
ofthis date -
:Not
Date'
Building, QfTiCial
Date
:Otlier OfMial
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` Xntalce to.complete omPlete The following:
i
Reviewerto complete the following: '
Square footage of Use:
Is use in LI, (-ll er PD11' zoning? if so, give applicant a :Certified
h� 1 N'
V
}
packet,
Engineer's Rej>orE(CEIt)p
Permitted as;
Y 1Under
wii acre be food preparation?
Section:
If so, give applicant a Ilcaltli'Department'fomt,
Zoning review can riot begin until we receive, approval from I4calth.
Sunpleinentaey regulations section:
1
Dept. FAX DATE
i
Circic.the:one that applies
blic wnter2—
Parking formula'
Is parcel on, pt ivaEc well rarr
If private well, provide I-tealth Departinent form,
Zoning review can not begin `until we receive approval from I:Iealth
Required spaces:
.Dept, FAX DATE
Circle the One that applies
Items to be verified in the field;
�
Is parcel on septic pttblicsewcr?:
Y 1,(?
Will you be putting up a new:sign of any kind? If so; obtain proper
Sign permit:Date.'
htspector
i,
Y 1•
.Notes:
!
.
Will there be any new construction or renovations?
If se; obtain the proper Perrpit,
;
Permit
i.,
Zoning tt:cnm Iete tltefoIIoSvlt ; '
_'
Viola ns;
Y 1
Proffers;
Y 1 .., . -
Ifso,-List:
Vat, nee:,
SP's:
Y /
Y '1
If so, ist:
C�'
Itso, .List:
I
Clearnnees
SDI"s
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