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FOR O 1 USE ONLY
CASE NO.
/ DATE SUBMITTED ►p 1 JL_
CONDITIONAL USE PERMIT APPLICATION
(CHURCH)
inimum gn>1remenb
$150.00 application fee.
Ten (10) copies of site plan which includes requirements for site plan proposals as listed on attached sheet. This
site plan will be reviewed by Staff, after which ten (10) copies of revised site plan will be required.
Detailed explanation of proposed use including hours of operation, anticipated traffic, number of employees,
number of students, children, ages of children, church members, etc., as applicable.
If sign is planned for project, site plan should include sign elevation and details. If sign details are not
included on plans submitted with this application, any future sign may have to be considered as a separate
conditional use permit and all of the above requirements must be repeated,
Use Only 0 Site Plan Only 0 Site Plan and Use
NAME OF PROJECT .84A2x?5 V-o,L -I r,
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ADDRESS LaY 0,0 C, e Y'E'Ass
LEGAL DESCRIPTION
APPLICANT (Primary Contact for the Project):
Name • o-~-£ y C;- 1e0_1J - P,_A_S_~ r
Street Address Q 22 3_J'-- Q, City ~✓k_ t
State Zip Code 7v E-Mail Address
Phone Number y ' ez 6' - J? 2 Fax Number
PROPERTY OWNER'S INFORMATION:
Name - M &Lic a.,,
Street Address a o l m* :.•o S7ti City - t Lj _}A
State % 7` Zip Code 7 6 1 E-Mail Address
Phone Number d'/ 7 - f 7 '7 - `13~ Fax Number 8 t ? - 8
ARCHITECT OR ENGINEER'S INFORMATION:
Name
Street Address City
State Zip Code E-Mail Address
Phone Number Fax Number
OTHER CONTACTS (Please specify type of contact, i.e. project manager, potential buyer, local contact, etc.)
Name CA/C-- r-ems.&e r.
Street Address City 41?r y'.
State 3?_4 Zip Code -2;) 0'f-~ E-Mail Address
Phone Number 41-0 7 Fax Number 5,7f2 -.?ISP
o:Tomis\plau\cupachur.doc
PRESENT USE OF PROPERTY
PROPOSED USE OF PROPERTY
CURRENT ZONING OF PROPERTY ® l
Total Acreage Z 5-'48 Building Sq. Ft. Floodplain Acreage
VARIANCE(S) REQUESTED AND REASON(S)
NUMBER OF PARKING SPACES REQUIRED
NUMBER OF PARKING SPACES PROVIDED
APPLICATION WILL NOT BE CONSIDERED COMPLETE WITHOUT THE FOLLOWING INFORMATION
ADDRESSED:
State how the following issues will be addressed:
1. Approximate the distance to the nearest night clubs, restaurants, and retail commercial establishments.
2 Discuss the possible necessity for screening (fence or vegetation) between the subject site and adjoining residential
properties.
/✓oi~ - ~eyc_~~ Arcs 3"~, f'(~-~e_
3. List all incidental uses along with hours of operation (including but not limited to school, day care, sports activities,
etc.)
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U P/-i/CC P~j' EJ Ip C J c//✓~J►-~ / ~.-~r ~yi ~r/,r 7~j G
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I verify that all of the information contained in this application is true and correct.
Signature of Owner, Agen or Applicant Date
oAfmms\planlcupachur.doc