HomeMy WebLinkAboutCLE201700100 Application 2017-04-24Application for Zoning Clearance
CLE 6 1 ? <2 �2. & _ v
� cilFl:z ��vLy
PLI�AS I :'VIEW ALL 3 SHEETS Check � C7 Date: � l
Receipt # O _Z Staff:
PARCEL INFORMATION
Tax Map and Parcel:
Existing
Parcel Owner: —VM4 �11
Parcel r tldra ss:315 U11�.�2city CV, 9J�Nt'k \ ,testate \'I Zip :� %.q
(include suite or floor)
kZ
PRIMARY CONTACT
Address : \
fj' state zip
Office Phone: ) � Cell # A,o1-�300I\ Fax # � E-mail C \P'oy
APPLICANT INFORMA"i" ON_._
Chk any first appCy: Change of ownership _- Change of use f hange of no New business
Business Namerrype:
Previous Business on this
Describe the proposed business including use, number as employees, number !)f jbifts, available parking spaces, number of
vehicles, and a dditional informatjQn that you can provide:
_.. _°iJ\L._
'1`his t Iearance will only be valid on the parcel ibr which it is afpro,/(A, Ifyou :hangs;, intcnsify or move the use to a new location, a new Loaxng
Clearance will be required. J
I hereby certify that I own or hav t own#,es permission to use thespace indicated an this application, I also certify that the information provided
is true and accurate to the best o kno iudge. I have read the conditions of approval, and 1 un erstand them, and that I will abide by them.
Signeure Printed :I;,,
APPROVAL INFORIirixnON ---__�
Approved 8.S proposed r l [ j j3iSSw
[ J Backflow prevention device and/or current test data .needed for this site. Contact ACSA, 977-45l 1, xl l7.
[ J No physical site inspection has been done for this clearance, Therefore, it is riot a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date.
Building
Zoning 0
Other Of
Crunty of AlbemarlM Delratrtmet t of Conim. anitry Development
401 McIntire Road C 9ssarlo&test l% , $ r, ; _02 v ois e: (434) 96- 8 42 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y / N
Is use in LI, HJ or PDIP zoning? If so, give applicant a Certified
Engineer'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 RATE .,-.,, -—-
Circle the one that applies
-),�;Ij e Is parcel on private well owur?
w art�
If private well, provide Heilt44 artment,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 public s
Y I N,
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / N
Will there 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: /000
6) 1 N Or�
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: /
Required spaces:
Y
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y /(a,)
If so, List:
Proffers:
N
If so, List:
Variance:
Y I(N)
If so"Tist:
sp's;
Y /
If so, List:
Clearances:
. ......... .
SDP's
Revised I 1/'] /2015 Page 3 of 3
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i
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm must accompmy zoning applications (Home Occupation, Zoning aearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, L�
(County application name and number)
was provided tothe owner of record of Tax Map
[naM, eC of the record Owners hers 4f tle P--cel)
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Hand delivering 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
PM
"D3l-
Mailing a copy of the application to �rc`c��CO`r1 a
.w [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 to the following address:
Date
[address; written notice mailed to the owner atIthe last known address of the vner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
iris requirement].
Signature of pplicant
Print Ap,lican Name
Date