HomeMy WebLinkAboutCLE201100134 Review Comments Zoning Clearance 2011-08-1008/03/2011 20:26 9724310
#0238 P.001/008
Application for Zonxn ' Clearance
CLE 13
OFFTCL+ US
PLEASE REVIEW ALL 3 SHEETS
Cllec bato:
Roceipt # Staff:
PARCEL INFORMATION
mr ` Q � � Existiiag•2<on,
Tax M-Ap and parcel: Jt °�
ParctlOwner-
city Or16tt S istata VA Zip ouq
Parcel Address: -
(includo suite oriloor)
S'RDURY CONTACT
—
Who should we calbwrita concarni.hg this proJeet4 (_
t aaK_ l h,P�ot bi 1 �,C city Dn1'Q �✓� State VA zjpW6 bQ
Addres; :
Office Phone; ( Cell# Fax# E -mail put cj tl
APPLICANT INFORMATION
Check ally that a' ly: Cbaa a af, ownembi Chan of use Change of name New business
Business Name/T'ypc:
,Previous
D'oseribe•the proposodbusiness including uso,.number of otnployees .inumb'er bfsh . vni lepurldne s' ncea, n tuber of
VA Lid ,rind am add'�tiogol inf 2ition thatyou can provide:
Y t
SAX-rz, D8 1" G1� 1 1QY Pay, {t i
aubl"A'
*This Cloarante %vi.11 only be valid oti the paroel rwhied iris vad. lfyou changb, iatewify Pr movq tlllsuac to n nevrlgoaeion, anewZnning
Clearqu4e will be roquimd.
Z Hereby certify thu 14vyn or•htzve the ovrndr`v pcornir;sion to We the spacq indicated on. this applieotior}. l el$6• certify dept Elie i*stnauon provided
ie true and- a c a to tits best of tat led c. ib road the condidoru of approval, apd 1 undctatand them,, snd.diatl will abide by dtcm,
Signature Printcd .� Z& -c['
APPROVAL INFORMATION
Approved as proposed [ ] Approved whit conditions [ ]'Denied
j 7 Backfl w prevention device, ondlor current teat.data nee=ded for this site. Contact A.CSA, 977 -4S11, X111.
[ .] No physical site imptcHon hap bepn• dona'for this cleft mmo, Thrrefotx, it is. not p dct mnirtation of eomplinncc with the cxistfi9g
sire p14n,
f ] This site complies;wIdi die slte•plaa as ofthis data
Notes:
Building OXcinl Date
,Zoning Official' Data'
Other Oitfcial Date
Lxuary or mucuilly a -UUVWI -1 ........
401,7yTeTntire [fond Charlottesville,VA22902 olcc: (434) 296 (434)972-4126'
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08/03/2011 20;28 9724310
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Intake to complete the fallowing:
Reviewer to complete the fallowing.
Squaro.footage of Use;
/ lrso, give applicant a Ccrtifiad
Is use m J, T-TT or PD'(P zoning.
englneres Report (CM- ) packet Petted as:
Diltl4jet Under Section: � 4 afa6d'pr pw'Ptionaparhne ltn
so, glue lemen[ary regulations section:
Zoning review cannot begin u it w eo ive approval m Health &pp
Dept. FAX DATE (�
Parking formula!
Circle the ono th4t applies
o
is parcel an privatewall ub c wet
Zf private well, provide Hearth DaPdrmcnt form.
'Zoning r0iew can not begin until we receive approval fifom TJaalth iieguired spaces:
Dept, FAX'DATF, _ __�— y / N
Items to be vuif cd In tht field:
Ci.rcle the one that applle
(s parcel on aeptle o ub .tc E
y /W.
dl you be puttiog up a nevi sign of any khtd? if so, obialn proper
Sign ptrtnif
t1 ere be any now construction or renova'tians?
if so., obtail a pro er Pen. 't.
Permit #E -1
?onin to coma lete'the,Lb whin r
viola ousi
y l
if so, Liv:
vAtiApce:
it`s�isC:
i
Ctearnbces-
I
#0238 P.002/008
Inspector : pate: �-
Notes'.
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