HomeMy WebLinkAboutCLE201100134 Legacy Document 2012-08-0808/03/2011 20 :26 9724310
t .
110238 P.001/008
Application for Zonxn ' Clearance
9..'
CLE # o� C (o 13
PLEASE REVIEW ALL 3 SHEETS
Clieck # hnto;
aecoipt # staff:
PARCEL INFORMATION 10 D
-ma Q66 eat 'Existiag•zon' m
Tax nfAp and Parcel:
ParcolOwner• Ti �r i✓ i
II /�
'r��J Yl1i �b J `T� a � l y C�i 16 0111 _ state U A z1p �
Cit
Pnrcel Address:
(iucludo suite oriloor)
PRLMAIti'' CONTACT
Who should we coll/writa con earning this proJect4 —�
11 gas :006(w, city R FJ Q L'_fl_stnta VAr zjpQW
Addres4 : .
0 Moe Phone; ( Call # Fnx # $ -mai.l f7 / r1 ' Im c61(
APPLICANT INFORMATION -
Check any that a ly: Cbaia o of ownershi Chnn of rice than a of nAme New bttsiaesx
Businoss Namerrypd: 1' " i✓� 35 �`7%� J _' r 3-t! Cbnd�•ni�dle�
Previous Buslnes; mi. this site
D'oseYibe the propoaedburirress lncludlnp trs0.•numDer of otnployees.nbmb'er bP.sh vsl IepacldnC s' ncea, n ntbor of
16 S
ye 'cl ,and am nddhiogal inf, �tion th>rtyou cstn provide:
Y t
r at u la GLY,
"This Cloaranco wilt only be valyd od thoparodiforwWch itiaAFprovad. 1t'you chongb, iatensify Pr move th;ruac io n new]ocation, anewZnning
Clemice will C c roquimd.
1 hereby certify tha 14vfn. or•hnve the own&a pmmilsion to ttae the sptico indicated on. thin it pgicotiori.. I eixa• certify thpt Elie i*rmadon provided
is true and- tic c a to rite bet! of Jar led e. I6 taad the coaditlons of approval, and I underatandrd3CYTI,.a�nddlstl will ebido by. thccir).
Signature Printcd_ ��.� L �'� ° `lA a.611 a
APPROVAL DMORMATION
Approved as proposbd [ ] Approved with conditions [ ]'Denied
( ] Beokflow prevention dcAce, and. /or current tear.data needed for this site. Contecr ACSA, 977 -4511, x11' .
[ .] No physical siteinspection leap b°pn donafor this cletu•anoo. Therefore, it is,not g do rptirratlon of compliance with the cxiatliig
site plan,
f ] This site complies; with die she•plaa as ofthia dale.
No tes:
Building O;fticitil Date
Zoning Officissl Data' c�
Other Offj'cial Drita
%,oual.y u, n iuwawuc a.ukw, ...,.... .,...., _._,.._._.._
401.Mclntire Road Charlottesville, `VA22902 olcc: (434) 296 -5632 :Fax: (434)972 -4126'
Revised 1/14011 Page 2 of.3
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08/03/2011 20:26 8724310
Intake to complete the following;
Reviewer to eompTete the fullawi:ng
Square. footage of Use,
/ It'so, give applicant a Ccrtiflad
Is uae m T,, T.T or PD11? zoning. /N Jv
gnglneces Report (CER) pauktiL penitied as:
�p
7
' 7
Under Section:
so, DlIffie,
g a fn6d'ptapEU'ation'Zepac❑ rm.
Zonng review can not beggii u it w ea live approval From Health 9uppleman[ary regulations section:
Dept. FAX DATE — 1��""�"'�1 I
Parking fnrrnule: ,
Circic the one th4t applies
is parcel on private wall o u6 a�,er meat form.
Irptivatc well, provide kSa
Coning V0.10W can not begin until wo MONO approval fxom T•loulth Required spaces:
Dept, FAX DATE 'Y / N
Items to be verif cd In tht field:
Oxcle the one that applie
(s parcel on eeptle o ub tc �cwo
�y be putting up a ntW sign of any kbid' if so, obialn proper
Sign portnit `trn 1
$er1nit# %L66 ) L1�
t1 arc be any now construction or renova'lians?
tf so,, obtait a pro er Pen. 'tl
'Permit #�
oniva to complete 'the, fol
Yloln ous;
y /.
If so, Vi r:
Y /' 'N)
if 0'-eist
I
i
Clearances:
#0238 P.002 /008
Inspector : Date:
NO.tn.
Y.
T2avi'WAN1 2011 Page 3 of 3
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08/03/2011 20:27 9724310 #0238 P.007 /008
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