HomeMy WebLinkAboutCLE201600121 Application 2016-06-06AppHcation for Zoning Clearance
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OFFICE 'ti'
PLEASE REVIEW ALL 3 SHEETS
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PARCH MFUR
Tax Map and Pared.
+ � r � � aat • . .
(include suite or door)
PRIMARY CONTACT
Who should rwe esswwrite con cerwal; this pfvjeet7 C S
Address: 3U Lzuop wra5m C'ity0Ap.¢L9W vU4,V Stag �J/�zip zZj
oflica float . &t) _ _-Do101 Cell 0 _ pax, ts
APPLICANT INFORM. ATION
Chest atny that apply; Cb*W ofownership .... _ change of
ausift ca Nama gyps:
prevwus Kansas on this salte
of now* ) Now business
A r A, a4-ff
IDescribe for proposed buss including use, number of employee, number of shifts available pamag "weer, ns mtwr of
vebukJod and arty addffionaat infaaraa mfion that you proviale:
*Tis Cat drill Only be valid eta tea pa=c for w" at i s appmvae, lw, use tO A new WVlktiarNS a rac y �r+a•
t leas m will be x nixed
i %bY ocrdfy 1 OM Of Dave owM's pa»Mimion m use 09 sp= Wic4ftil an this Amikown. i Alw nattily that *4 mfonWion pmvJ3 cd
is vue a>aal the of my l wlodge 1 ltsve teats the nditions aiappmval, and 1 wxknuAd, dicon, that 1 will abide by tiaxxra.
Signatsme .�.� PrintersAke% a &
APPROVAL INFORMATION -
ApMved as proposed i l Appal with conditions Bard
Bac low prevention device a Wkw eat lost data needed i'or this site. Con= ACSA, '17-0 i 1, x i l 7.
j I No physical site inspection hats been done for this dace. There we, it is not a derma adoa ofcompliwice with the,. exisang
site plaa.
( I This site trsa miles wM the site plant as ofthis doe.
Not".
Building Official Date ('X / .._.. .....
zonug Official late /�a/b
Other Official U Elate
Ctoanty at Mbemrie Mportment Of Community Development
401 Mielntare Roan! Chaarlotter4lit, VAR 22992 Voice: (i) M-58327saac. (434) 9724126
Revised 1 lfll2013 Page 2 of 3
Intake to complete the following*
Y 1 0
is use in LLHIor FD1P zoniag7 Ifso, give appikani n C.eriifred
Engin 's Report (CER) packet.
YJ&)will ere be fbm preparation?
If so, give applicant a Health Department form.
Zoning review Carr not begin until we receive approval 15Mm Health
Dept. FAX DATE
Circle the Otte find appI,
Is parcel on Private Welt i—Dwstee
Itprivatc well. provide fly artment form.
Zoning review cm not begin until we motive approval fmm HoWth
Dept. FAX DATE
Circle the one tit ap
Is parcel on septic oCoLbUe s ?
YIN
Will you br. putting up a new signs of any kind?
Sign perrrdt.
PeIndt # . _
ReA to Comrpl-te the following. -
Square foots of Use:. -71
7 9
Od as: c
Under Section: e.eT&
Supplementary regulations s tun:
Parking fca-mula.
Reqrntrxl spaces:- --
YI
Itms to be vedi ied in the fold:
If so, obtain VmM
�tssF' ; ii�taE:
YIN
Will them be any new 008struction or Movations?
If s% obtain the proper Permit.
Ptah #
to complete the
YIN
If so, fast;
Varrtstce:
0 1 N
c1taranrest
Notes:
Proffers:
Yt�if st:
SIN
If so, Last:
111112015 Page3of3
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