HomeMy WebLinkAboutCLE200800111 Legacy Document 2013-01-16Application for Zoning Clearance =�� °�
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❑ Zoning clearance" "$35
PARCEL INFORMATION �� � D /!
Tax Map and Parcel: / Existing Zoning (fL
Parcel Owner:
Parcel Address: 1 1 &�Yk i rNU X oa city Ci-oa v' it State VIA. Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
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Address: Y 5D M AWI VOWO LA) City .fit TV; t State VA ZiP Z24
Office Phone: . Q2)w 27`? Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: l:AC{ /e- 7) j"t,,T l - ii%_c7#"iSCU' %__ rr; A. L. L_
Previous Business on this site �1i 5 3� blf, -ALek 94 0
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: d ?rylp!!5A& Csf- C f A! S C
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate t e st of my knowledierlia .0read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed —D/i,iLi` "eL. ,, fm a
APPROVAL INFORMATION
[ ] Approved as proposed " [ Approved with co
Intake to complete the following:
Y /0N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
WilQ11 re 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
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Circle the one that applies -`-- Parking formula:
Is parcel on private well public �tef?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applies
Is parcel on septic grfublic se_ wer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit
Permit #
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y Notes:
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3