HomeMy WebLinkAboutCLE201700067 Application 2017-03-10Intake to complete the following:
Y/NQ
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / lJ
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 o public water?
If private well, provide 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 septic or ublic s wer�
Y /Q
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will t ere 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
ermitted as: t2P:L c.c, (A4
Under Section: -I y. 'Z- -/
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/()
If so, ist:
Proffers:
Y/Oi
If so, List:
Varia e:
Y/
If so, ist:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 11/]/2015 Page 3 of 3
EXHIBIT "A"
182 SPOTNAP ROAD #B1
1904 sf FLOOR PLAN
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home 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, (��,� �; Ca'i; c��� - � 2-ln .�; (1(E6c`tL4cE
[County application name and number]
was provided to `.av,,-( 09ic e, �t �c�; (�;,.9 L,- �� /� � the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
L2f Hand delivering a copy of the application to }- 14L 7 7kS fFE
[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 yac- � � �t)17
Date
0 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].
Signature of Applicant
19iye-CCC r- /.,'ZC,,-le,
Print Applicant Name
3 A /�
Date