HomeMy WebLinkAboutCLE201100033 Review Comments Zoning Clearance 2011-02-14COMMUNITY DEVELOP %MENTI Fax 4349724126 Feb 4 2011 02:42prn P003/004
Application for Zo ing Clearance
CLE #
oI; FzC)E Us)t OINLY
PLEASE REVIEW ALL 3 SHEETS Check # `) . hate: Z-' �) ' IJ
Receipt ## S f Staff• 1
P.ARCEE INFOR MATIQN ..ten., i
Tax'Map and Parcef. 0 % v nD�J� -!?.' I Exiistutg a.�v11wn �' I l �
Parcel Owner;Lam' �1it �2 vim lt/J a ✓,
Parcel Address: � • v • ��' _ C1ty ClnvwQ`A � tA_ State Uc� Zzp'1i7� 1 \
(wclu.de Suite or floox y,.t (�Zj
PRIMARY CONTACT
Who should we call /write co)<tcexaning this project?
I
L`c� State (�-� 2ipq'-uA i k
�;.daa�ess : I�(o 5 �1•- „i,�,C ,..,• C�' T� � �c�c3aity G--v �
Office Phone: `�-�i 6� OoCell # Fax AJ-n 617 E -mail .a -�`I f_
APPLICANT ZNEORNVUTZOI
Check any that apply: ' Change of owuersbip Change of use Chaia a of name New business
Business Name /'Type: P /rS1
Previous Business on this site
Aescribe the proposed business including use, number of employees n mbe�C of shilts� ava�Iable parkin spaces,, ber of
vehicles, and any additional information that you can provide: ��c� �c� o lac �^c -
c: ,
*This Clearance will only be valid oai the parcel fur which It is approved, If you change, intensify or move the use to a new location.. a new Zoning
Clearance will be required,
Thereby certify that I own or ha-,r, the gwnex 5 penpission to use the space indicated on tbi5 applicati4Ta. I also certif''that the infouroation provided
iS true arld accurate to the best of my lctnowledge. I have zcad the conditioms of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL IN)FORVLA.TZO"N
Approved as proposed [ J Approved with conditions G J penned
[ j Dackflow pzevezntion device and /or current test data needed for this site- Contact ACSA, 977 -<45l 1, xl l7.
[ ] No physical Site inspection has been done for this clearance. Therefore, it is not a detezzxnination of con;apliatace with the existing
site plan.
[ ] This site complies with the site plan as of this date.
IN otes:
Building Official
�- Date
Zoning Officia) Date
Otlaer Official Date
l..,ounty 01 'kw 0111aric LcFUI Luiclli v1 �a,u,au..,....� .. • ..�. -� - - -___
401 IVIcJ) tixe Road Chaulottesywe, VA, 22902 Voice: (434) 296 -SS32 I” ax: (434) 972 -4126
P,evised 1/l /2011 Page 2 of 3
COMMUNITY DEVELOPMENTI Fax 4349724126 Feb 4 2011 02:42pm P004 /004
intake to complete the following:
Reviewer to complete the following:
ZA4 a Y-
Square footage of Use; 7 27
15 use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CIER) packet.
/ N
Permitted as: d(o —
Y/
WiIJ ere be food preparation,?
f
Under Section: 2 o�A
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section.:
Dept. FAX DA YE
Circle the one that applies
Is parcel on private well or ter?
Parking formula;
a
r Vaxi nce:
Ifs , ist:
if'private well, provide Ile epartment form.
Zoning review can not begirt until we mceive approval from Health
Required spaces: —J
[[
Dept. FAX DATE
x/
Circle the one that a�
-l5 parcel on septic or ewer?
Items to be verified in the field:
Iy /. N
Will you be putting up a new sign of any kind? If so, obtain, proper
Sigit.perrrrit.
Pear }t ##
Inspector Date:
Y / N
Notes.
Will there be airy nrrw construction or renovations?
If so, obtain the proper Perrnit.
Permit ;#
Violatioxts:
o,Zist:
Proffers:
If so, List:
ZA4 a Y-
r Vaxi nce:
Ifs , ist:
SP's:
®/N
Zfso, List:
O5
I.
GAeara�,ces:
SDP's
Revised T /1/2011 Page 3 of 3
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