HomeMy WebLinkAboutCLE200800178 Legacy Document 2013-02-1910
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Application for Zoning Clearan.c6
�IdLE,, 9 7- 009. tli
,A)RCELMORMATION
—22k 'Existing
Tax Map and FArrcl,061DO-00-00 Zoning
(010.<204b ZZL-C
Parcel Owner..
FArcel Addri,,ss: 0,4-s-(-5�kitya Tin
(include suite or floor)
FRIKARY CONTACT
I-11ho should we tnll/write concerning this project?
0 7- 1b 74
Address: -S -city _zip
orare. Phonf-,-. L-XJ �2 ff-3:9a,8cen
APPLICANT W, ORIYL4TTON
s"l N.,
W.ii
Business Nniivieffype; IAID�
Previous Bivinem on tW site—fe JV'*1-1-147A;Ck S:�fvl< (Z
Describe flic proposed bus➢lmsR including nst, number of employees, nurabor rprSHRS."milabi Ri s S. number of
'�ez �S 01
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veh' les and any ndditlonaWnfarmatiori that yo cm provide: ;16—qJP& Y* /1V/'J ffA4443
9� SeACk-7
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*This Clearonur. will only be valid oji Ifit: parcel Tor which it is i1pproved. If you change, 1ntn-nq-t7-7—n—r7Tc—iYcthc use to a now location, a nr-W Zoning
Cienranizo will be required,
I hr-rrb.y certifj ibmt I own or have thr ovme?s permission to use the space indjoeted on this oppl-oadon. I 915o c8ttif5l that the information provided
is true and Eicvu-ntr. to the best of Jokowledgo. 1. -.Eirl the condiLions of approval, anti I ur darsLand tilmm, and diet I will Abide by thorn.
SignatUto Printed
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County of Albe-Insirk Deparl!MWA of ComMunii.-Y DeVnIopme0t
401 McIntire Road Charlottesville, VA 22902 Vulce: (434) z Ci--EiSM F49Y., (434) 972-4126
Revised 04/2 9/0$ Page 2 of 3
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Intake t complete the followltlg:
Y/N
Is us❑ in I,% H or PDTP zoning? If so, give �ppliea.nt a Certlfad
Gnginnor's Report (CFI .) packet:
Y/®
Will there 6c Nod preparation?
Ifso., give applicant a Health Dopartment form,
Zoning review can not kgrin until we rnceivc approval from 1-lealth
Dept, FAX Parr.
Clrclo the one that applies
Is parcel on I)rivnto well public water?
If private well, provide }-lea form.
Zoning revicbv can not begin until we receive approval from Health
Dept, FAX JDA'I t
Circic the one thM applies
Is parcel on septic or public Sewer?
Y/N
ill you be putting up a now sign of any kind? If so, olitain proper
Sign permit.
PermlC;4 f3 Zoo R100,�f80 S`
/-N
ill there be any now conStruotion or renovations?
Tfso, obtain 'ho roperkermit, �1
Permits 9�6&ol'-d!22 z�;^ �
7 ..,.:.... �•., .. n. r., ..1..4•. 41, 0 f-111— w h4 rr-
Reviewer to complete the tbllowing-
Square footage of UsE_ Al2J
R N
omitted as:
-
Under Scrtion:
Supplcmcntary re;;ulations section:
PFlrlcing formula: �!
R quiredspsces;
Y/N
Items to be veri-flc•d in the field:
Inspector:
N otrs.:
.Date:
Yiolnt'ons;
Y lrN�
1f S0, 1$t:
Proffers;
�`
VJINA CC.-
Y /<NN
If so, List:
SP's:
Y / N
if za, List;
Clcarnnccs:
SDP's
Revised 04/29/08 Pago 3 of 3