HomeMy WebLinkAboutCLE201500248 Application 2015-12-01Application for Zoning f learance "z
CLE#
OFFICE USE My
PLEASE REVIEW ALL 3 SHEETS Check # CCAS Date: I) a_3 �l
Receipt # Staff: AS (Z
PARCEL INFORMATION C�
Tax Map and Parcel: �JA I V-1 Existing Zoning
Parcel Owner: A 0 At G�[,t
Parcel Address: C]ai-&6&\5 Q)) V City Oc i -164+f5 til %tate
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? [Y�• ! 1�-► �' d Pt �-'
Address 9) 4-y' l UL. f1\1 City taIcC' L. s);
Intake to complete the following:
YI
Is sein' LI, HI or PDIP zoning? If so, give applicant a Certified
Engeer's Report (CER) packet.
Y/N)
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 or,Cubl.i:;.w�a
If private well, provide Healment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic orublic sew
Y /4
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following: 0
Square footage of Use:
�IN
Permitted as: — pi b ti Ge _ P�A�e4
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violat�'ons:
YI1J
If so, ist:
Proffe :
Y rNI
Ifs , ist:
Variance:
N
List:
SP's.
Y/t1sol
If so, List:
Clea rances:
SDP's
Revised 11/1/2015 Page 3 bf 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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].
Signat a ofA plicant
rn 0+70414 -
Print Applicant Name
Date