HomeMy WebLinkAboutCLE201900015 Action Letter 2019-02-229
pplicatonfo Zo in Clearance ; `a
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Receipt tf staff.,
. PA12C11, INtioi2!ta,-a"1 It)/:�� 1 s��
Iax'1lnpstad parcel: (�7G��M i �-. Q-.100 oa 04 lsi'tting Zoning.
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Marcel Address: ✓�✓ t'rrrt,ilGt l!._vsf°Ith _ i it1 VIGlC.I4ZTz"J1111 41au __. v{� _ — ail',%4
tinclude suite or "(rot)
1'12 AIA14Y CONJ AC."7 (�
Who should see califs riot tuna ruing this project? ._M..
l tAddrraa :. / ^ Ci ly State / Zip
office Phone: Cell elf a C 7641 � IVW ....__. —:.__ k-mail C--lira r 1,4. gib': ! le
of
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FAPI'L IC:AI• I' 1KI (JIZN1A11ON
C lrcck nth hal a npl Change of ons ntrsbt n Chirngr yr.use Change of name !\rw busintst,
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�I'r'estousllu+,btmonUitssilt_—.
I lieser1he the pmpptised bushncss. including aye, number of unploYecs, number of IN115, available parking spacep, number of
st�trlclr5,:i anvatft)ilianullnlnrnr+itiani I anon it 5irlr:_ff�'r" ��- Y1i,--
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C f ,intie will b. mquriwd
I I.ersbg s.rnly that I Owl In luivc this sae id. -I lntiuix�>i0n to riK 11a ,'pane uii3watsd on fluor applitalum. l also cerli4 th t the uyh3n'r ip ii t�tt�,i.jiY1
ix trot nail a=iotaae to flit ht a „ n t.noiaedk 1 lietie Uiid fl e c+niJdlonS ai •iphru;al, :oid I wider land Ilmn and that I w l{ ibid ty i .m
Sif;naftar ( f;y-��__.,.
APPROVAL IN1 ORMA I ION
XnApproicd its proposed j J Apt+r�»cd sstlh rc,adtnv nti ( ] Urnitd
j J ptti;6flow prevention de,virc autilr, wirvot test data needed for thus ,rc t't, tall .ACSA 977.431 I - xi P,
j J No PItysleal site inspetttimi has bcvri dime for this cic:uomc I im Mire, it rs IwI ,i delefluinaUtin of r.;n IpliauL;c %kith ilie existing
Ott plan
j 1 'h hn,�, silt.: complies ss-ith llic. site plan as cif lbis data.
Building OMC i
74Uning I:lMCial
Other ()flitcjgl
Date
._ County of .Allitnatrk Dep' llmrnt of C ointnani6 Ut
401 sli buirt hood Chath ittmilie, YA 127U2 A riftti (434) 296-51
itputeirt
1'nt: (434) 972-4126
lietisccl I I I ewer f i I'itt;C. 2 ii1 :3
Scanned with CamScanner
Intake to complete the following:
Y/®
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil ere 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 ublic wate .
If private well, provide Healt epartment 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 public sewer?
4Y / N
,ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /Q Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to comDlete the followinLy:
Reviewer to complete the following:-^
Square footage of Use: 2) I�" -T
Y/N /
rmitted as:�lJ't
Under Section:
Supplementary regulations section:
Parking formula: S J (0
0c)
Required spaces:
Y / N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y / N
If so, List:
n �� n
'v C
Proffers:
Y / N
If so, List:
M 7� —
Variance:
Y / N
If so, List:
1� (�-��
�V
SP's:
Y / N
If so, List:
�
I" C7ne—
Clearances:
(, �/ QI
SDP's
L
o
/
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S
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Revised l 1/1/2015 Page 3 of 3
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, Z6 K1,(\
[Couhty application name and number]
was provided to 5 +h S l ,cz-A S �-4 ,a-\ Ve 1-1-L - the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Numbery-� b M I - 0 0 - 00 - Gv 2 a o by delivering a copy of the application in the
manner identified below:
✓f Hand delivering a copy of the application to S S4 Ct o ,� Vc n�� �c LI-L
[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 (>L. )C)I j 16l�
Date
WMailing 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
Print Applicant Name
C:;i_ / U, \ ) Zu 1 I
Date