HomeMy WebLinkAboutCLE200800183 Legacy Document 2013-02-19'ummu"lly I)rytLUPMENTI Fax 4349724126
Aug 13 2009 11;19am P0031004
APPRcation for ZOIU'Jff- Clearan77aP
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PAR
Tal MaP and Parcel-
Parcel ovmex-.. F-Xjsftgzo
Parcel Address: STS I
" 5 " k ( 01197Z
(include suite ox AIooX) &WIO / Y--Iie-
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,
)NT-ACT '
VVbO should we caWwrite coAcerWng tWs project?
Address :J city — — — -------
Office Phone. CeIR # --------- � Fax Zip -2ZIO-1
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71
Previous Busioess 0A this site
))e8cXib,e the Proposed business including use, number of enplo
V*Cles, and an additional inf, y num�bpr o h'ft
Ormation that yon c OvIde. � rAe. available arking spaces, nnmberof
*This lwanco wall 0* v4 id Clearance will be rcqaked. the PaMCI IDIr which 't ts apMvcd_ Ifyo
YO cbonge, juten,.
or move 0 a n location, a w z
lhemby certify th I Own or have the O"erts Polmaission to use the space indicated on J:Ws applir
is frac aw O= best ofjmy kaQwe4ge. I h4VI 78d conditiom of 'atioz JSQ -Ttify that the information approval�Aud I undmtand them, omm4tion provided
Signature and that I wW abide by them.
t A4
401 Nifclafite Road aarjottegQk, VA 22902 Voice: (434) 296-5$32 Fax: (434) 972.4126
Revised 04/28108 Fa9c 2 of 3
, 1, 0
6ummuniiv DEVELOPMENTi Fax 4349724126
Aug 13 2008 11:20am P004 1004
btake to complete the fojjowinag:
Y / �'.a
use izt LI, I"U or PDIP zoningr If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�
Will there be food preparation?
If $4, give appiicant a Health Department form
Zoning review can not begin until we receive approval from, ..Realth
Dept. FAX DATE
Circle tho tine that applies
Is parcel on Private well abbe w�'-uojm.
Ifprivate weal, provide FIealt ep
Zoning review can not begin until we receive approval orq HeHealth Dcpt. FAX DAB fz
Circle The one that applies
Is parcel on septic 0Cp blic sewer,
V/ N
Sign You putting up a new sign of any l�xad? if so, obtain proper
Permit #
Y /
Wiil ere be any new congtmctlott or renovations?
Xf so, obraa e
Penmxt #
to corn )fete the
kievlewer to complete the following:
Square footage of U'se.
Y /•N
'txed as:
Under Section:
Slentary regul s coon:
Parlcdng formula:
Required spaces;
Y/
I Fbo cc itied in the field:
Inspector:
- Date:
Notes:
..,acv WJA :
Viola n
' s:
Y
If so, st;
Proii ;
Y /
If so, xst;
Z'Aa'l ce:
CSC
Isoesf:
/N
so, List:
Revised 04 /28/08 Page 3 of 3