HomeMy WebLinkAboutCLE201500173 Application 2015-09-03Application for Zoning Clearance
CLEI#
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # i. j 5 � o Date:
Receipt # fl__
o f �- ,t'7 Staff:
PARCEL INFORMATION
Tax Map and Parcel: –Grs ,j Existing Zonin / c
Parcel Owner: &114
i
Parcel Address: U .S'aZ "p,:g City State_ LL/2' V�,,4
(include suite or floor)
PRIMARY
PRIMARY CONTACT
Who should we call/write concerning this project?
Address � ry� L'
CiVl' f'27 ri/.//6? Stato�/� Zi
.�^ p
Office Phone; Ctno FW- i'dYS Cell #
Fax # —E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type,
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify ormove dte use to a new location, a uew 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 are o the t ofmy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature printed
AP OVAL INFORMATION
Approved as proposed [ ] Approved with conditions
r ]Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site pian.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date Zy
Zoning Official Date
Other Official Date
County of Albem.9He Department of Community Development
4Ut 11Lea11,11'Chii:iu 1.11dt1uEzca,..ic:,'tri����., s•�.�4. �i� 1� �n' re'1^ F.y. �.1.2i1r,•*� y�F
Revised 7/1/2oi 1 Page 2 of 3
Intake to complete the following:
Y1 6%,
1`�,U nrt t�,PJ
Is use h LI, HI or PDIP zoning? If so, give appl ant a Certified
Engineer's Report (CER) packet.
Y / I
�
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
Circle the one that applies
Is parcel on private well public water
If private well, provide Hea eparbnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies_
Is parcel on septic o ublic sew .
Y lC>
Will you be putting up a new sign ofany kind? If so, obtain proper
Sign permit.
Permit #
Y /Qtere
Wilbe any new construction or renovations?
If so, obtain the proper Permit,
Permit #
7.nning to emmniete the fnlinwina:
Reviewer to complete the fallowing:
Square footage of Use: S �
Y I N
r 1
mitted as: to
Under Section:
Supplementary regulations section:
Parking formula: 14
Required spaces: Aq
YIN
ItemVe verified in the field:
Vi ions:
Y ,
If s ist:
roffers:
/N
so, List:
�� V
i
Variance:
YIN
If so, List:
's
/N
so, List:
Clearances:.
SDP's
Revised 7/I/2QI I Page 3 of 3
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