HomeMy WebLinkAboutCLE201600253 Application 2016-11-213
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Tax Mays and Parcel:
Parcel £9Yi2Ar: 1F �S. -_... LLC __... ._
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Previous Busiuess on this site
Describe the proposed business including use, number of employees, number of shifts, available ptrl ng spaces, number of
vehicles, and any additional information that you can provide:
I hereby ccrtiaiy that i ow; or i:ave the owner's permission to use the space indicated on this app'rcation. 1 als€a certify that the information proyidcd
true and accurate to the best of my know edge. I have read the conrl'x or,,s of approval. and 1 {understand them, and that I wdl abide by t,'aent.
. __..____..... . __
Approved as proposed Approved with conditions [ ].Denied
Backflow preventiDn device and or current test data needed for this site, Contact A.C:SrA, 977-4511, xl 17.
(. ] o physical site inspection has been dome for this clearance Therefore, it is not ad etcrm ination of cornpliance with the existing
site plan
This site complies with the site plan as of this date.
Notts:—
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Building Official �...... _._ ...._ _.._._ Dat�_....... �.�I �. i.�
Zoning Official
Other Official
.._......... _
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Revised 11/112015 rage 2 of
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Intake to complete the following:
YIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 6
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 p If private. well, provide HcalthGeni form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl!'jcs
Is parcel on septic 0 ublic sewe--'/
)y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perinit,
Permit #
Y /
Will �terc be any new construction or renovations?
If so, obtain the proper Permit,
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
�/ N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: -")--
T, - -- ...........
Items be verified in the field:
Inspector:
Notes:
Date:
I violqtious-
I Y / 19
If so,lisi:
ProffeM
Y / IV
If so, List:
........ ... ....... . .
Vartknce:
Y / 0
If so, List:
SP's:
. Y la
If so, List:
Clearances:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3