HomeMy WebLinkAboutCLE201300021 Legacy Document 2013-02-19Application fo .r ninj Clearance
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Map and Pmrcri Ot:OOO� o�aty a?So cr - -._ �xitrtS�{ Tunitag.. G! r ETt` � �1 i �tMElC r�
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PRIMARY C ONTAC'"I' _
Who tthoald this pr9,jtd7
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APPLICANT INFOR14ATION
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Pervious Bmittedsso+a this site
Deacribe The pC'44maell buamms inchAng !t w, number samber of Aft n'vaillabit parkIRS $Pam, nnn ?her of
vehicles, wnd tty add! !anal #a[ornwtfxua tbttrt you csa pa+trwi&: �. ' + /�- +
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T 11060:
"1lus cir. mss aril only ba valid wt the trsarr.1 kv r,tich it ss a;Tury asd. i' YK.W4. �,: C, �nJCM fy ua mrxwc the use 40 s new JvXA XWI. A nCW Zurtiq
Ommoce will rw ftqui+ta.
I htrc .} etni fv that l awil of have the 4 �rTw 's jk- M%V4u4sn ur iris V'rt w;wc cw thil, syays oa whrtt. t amt "cirt0y thall the gd;DMI01 ift Prigs
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APPROVAL INFORMA1 ion
Approved as proposed { i Apgtr;rwd w%h c4ndawwn I Denied
j ) Bb kflow {mvemtitn device an for carom tt*a da4 tiecdol far 414 shat•, Ct cgw t Ait"- A.., W-14511, x 1.1't>
( j No physrcal site invpwitn KAs tic m dorm fkm thii ckt F itirr itc, k is nr,.,1 a dcEC mirA ion ofoompliarwc with tip existing
0k plan,
( j Uis site exrrnpdics wrtli tho sett• plan as of Mrs dlatc.
[3uildinu ( ?4itcW r - F-. -L^ attic (R3
Zoning OffIcia1 _.w M y [late
Other f ?Mdal Date
f.AmWy 4 Alhe>iewsrle. Dep utm m of Cana o4wity D"'elopment
401 Mctnth m Read Clawfoutsvik, VA Z.M2 Voice: (434) 296-gM Fax; (&Uf 972 -412A
lte iwd 7! t /3011 Pnga: 2 of )l
Deincomplete the following:
, HI or PDIP zon ing? If so, give applicant a Certified
Report (CER) packet.
Y N
Wil ere 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
Circle the one that applies
Is parcel on private well public water?
If private well, provide Health epa ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is p el on septic o public sewer?
Y N
Reviewer to complete the following:
Square footage of Use: 0o
O/N
Permitted as: �', ! ((! C.
Under Section: •2'; .2
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
IterMo be verified in the field:
Wi be putting up a new sign of any kind? If so, obtain proper I - -
Sign permit.
PeDN
Y Wian y new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Inspector:
Notes:
Date:
Violations:
Y /
Ifs ,List:
Proffers: _
N�
If If s2 b , ist:
Vari nce:
Y/
If so", —fist:
SP's:
®/N
If so, List:
-7J7
-7 — s�
Clearances:
SDP's
F
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Y*bfarm nwir zwompeolry zmIng &ppik-lakm (lime Otexpation, Zoning Chrarance, Zoning
A4miakorawr Demrainddoju ar Appmh,,S4s Pernift, HsiWtg Pernks) of the app katfon is not the
owpwr.
I owify that mice of ft sWir-stion,
lCourity application name and number]
wu provided to the owner of record of Tax Map
InAme(s) of the MTOM Owners of the parcel)
mid Puccl Ntimbcr ekijvcriaj; a CWY of in the
nunner idetoificd Wow
I V 41
INSON of the recom OWW if & record 097—il —a
perwn. if the owner of woord. A an onmy. Weabfy ft avipisw of d". mwtml and the recipient'.4,
tilk or oflke f(W dot owityl
on
Mailing it copy of the aWication to.__
Name of the rbuxO owner it Ow word owmir is a pawn;
l y, Wemi4-tbe lmvpwilit of the recwd sjW the recipient's title or
office for thw entity)
on to t k4ke*vrj uldms&
Date
faddreu, written not aw-i led to the awrw as the kast known ac dmu of the owner as shown orl
the current real estate tax awsczment books or cun=x real estate tax w%mmmi records wishes
this requirement),
Sigrasurc of Applicant
Print Applicant Name
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FOR,
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