HomeMy WebLinkAboutCLE200900187 Legacy Document 2012-10-15Applile a do inn.. -fo-r-7-6.0 learamee
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Ing Clew ace = $35
A-�V, RITEENV ALL 3 SHEE TS
OFFICE, USE, ONLY
- - 11
Receipt # 7M� Stat"P_
PA R. 0 L INT O'RMA T 10 N . ....... . ........ .
Tax Alml) and Parcel: R-xiitiag Zoni
Parcel Ovvxier. ero_z_e� wpt VIC/ bl - LIU L_
0 , (— \A/
5-17% T4\4-_e_e_
Parc•l Address. 2 State
t't'
(include suite or (1.00r)
PRINLALRY CONTTACT
Who should we call/wOte comemling this pro jec�?
Ad()IMS �.k'AAA a1v K_UL� State V4T zhi
P
If -,z4cy
Fax E-mail vj'A
e,
A-PPLICANT ENFOILMATION
y tha!_�L)p ge ,e qse
jy,_ -_han�ofownershlp Chaug Change of name Newbo.0
]Business r LJ-L
)Rravlolu Business on this site L
Describe the proposed business iachicling me number of employees, lumber of shifts,Avalla le a*1a'nspaceq,ntj))qbe of
Yvehicles. atd any additional information tbat you can provide..
_Clefxsnoe
T�F�.' s mi Al o z i ly b e vali d rz i the p sac c-1 b r viluch it 15 ippyoved. If yoll chun6e, inttnsify or movo the use to anew 1peatie'll, L nev"Z(�Iill-
Clearame will be required.
I hereby certify fl, 4wil or Pave the 0) ne ` ell on To Ilse; Spw."Cirldfoaterl Oil dd-� arpliLati4n-
True land to flic. b St•.. ..die. I have qed the condidom ofap1novalei d I 'Onderstimd thonj. d thar. I will abide b,.;- them.
Signature Printact
ATP tNI�ORMATION
prowed as proposed
-Back:iow
. -nied
- ievict
prevenuan. c anc ii
1 No physical site inspection has been darie fi7r this oloarmcc.
site plan.
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Notes;
Buildbag-Officifil Date
Other Official
Date
County of 41bamarle'Vepsirtment of Communi4, neltelopmtvt
401 Mdutlre Road Charlottesville, VA 22902 Voice: (434) 296-5832 PaX: (434) 972-43.26
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ale 2 3
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POO/Md TPK!60 5002 U 100 MMUMP XBJ UNIMOIDAIC LING OO
1(v/v\_
Intake to complete the f'ollowin.g.-
y /N
Is us xfl or I' L7X Ea zoning? If so, give applicant aCertfieCT,
Engineer's Repoit (C.EX) pack-at.
Will ire 13o food preparatimi?
If so, givo applicant a Health Department Pan,.,.
ZmTh-19'wirw on not bogin mitil we rei4eive approval from Health
.Crept,. FAJR D AI %
Circle TEE one that applies
Is parcel on prNate weU or putdic iv ter?
1fpriv&tc wall, provide. Heal* Cqfr6tn-vent fomi.
Zoning reviev• earl not ")eginuntil we receive approval tro Iioslih
Dept- rAX DXfE
Orclo 'the one that sp lie
is parcel on septiv oT P1 ic Iver,
Y N
Will yo-abo Putting -tt.si-811 of X-, kind? If so, obtain propax
Sign perrrdi%
Permit # 7
Y/N
Will .;Ction or ren", v., It ions,�
If. ED, ObWln The proper I;c
P4?rmft 41
Z22Lui&tO complete the fbUowj!jg-.
Y
ti
Variance-
Y 1(
RHVieiyej- t(O cw;ayl ltc the
17 /)0 C) C
N
Ulder sectlan!
Paxldng A
Required, spaces:
X�
ITrmls to be verified in a 6 field:
lwpu-tor:
Notes.
y
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..............
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