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HomeMy WebLinkAboutCLE201300140 Legacy Document 2013-07-29Application for Zo ingyClearance '�O - 0 CLE i�, OFFICE 118 2 -PLWE UvfP1W ALL 3 SEE, FITS. Clle& # Wei Staff. Receipt # PARCEL WFORMATION � NnU U�MM a Tax Mag and Parcei Lxistig Cttrin lxsircelOwner* G e4 Parcel.Addefts: city f i9 rJryt, tote 21P e rr1 + (include suita or floor) CONTACT .-PRIMARY who should we cawwjiie concerning fh s project? r'a`t i���n� ' � City "''�I�Cc' State Zti? Address1�!`i . t3ce Phone: ((}+.» `` ^Cell# fax # /a/SSa E-mail fun% MART DWRMATION Check any that apply. Chane ofosvnersiup Change tlf use Change of?tz e -New Business . Y� Busing ss .?Nameti'ype: "Pre<vions Business on this site Describe the, proposed business'includingusff number ofemptayees, number ofslilfts, available. ,parldngqpacesi number, Of vehkies,: and any addition0l informstion that you can provides Cleamce wait only be valid on ft parcel tar which us ao travej?; Ifyon ng ..intans "sly: ar move We use to a ne +y Is�earion, a ae�v Zornng I hereby certify 191 01vn: or theovet rs omission to lase the spacx indu 9 on taus appilmaiinm -f also aarti"' `tb at the iafoMITion provided rn}+ knob t.,I:heYC ttad'tlte cx�nions ofzrn!ai, sndT undcref.�nd tfr�.d X71. ltle by them is tr+!:xsd. arcutaie` h7 flf atS Prhftd Ap.prnved as,proposed Approved wlth condikdas: } benied I. ] Backf ow pceventlon device and/or 'cutmnC test data needed fr.thissitc Contact A.CSA, 977 - 45117 x117. NO.:physical site inspection has been done for this clearance. Thcrcf6m. it is Dot a determll dOn a cOmplia e eaisiiu� sip plan: This site complies with tlje,s C plan :as of this date. ilotef. $tt ding Offiebi Date i?nfe Zoning offirzial other ()ffloial ;;late lrOURTj". Q }}jl{jL'IItfi£3GLCl,Jnl:i4iw4of 4 tire Faci ChariottQSvi lief "l:A. 9(i "Y© ice: (434296- 5832,Pax. (434) 7Z- 26 Revised VIM11':??* 2 aft 900/zoo d 9.8.6.g �`fh X811 80881 G.9ioL QZh t? 91:.;n1 EL:Cr 7,fr.lta"�;1�. Intake to complete fhe following: Y / N RevIerer to complete the following: Squam totage ofUse: 1- 9 - — --- Is use InL4aorPDP20nin9? Il` so, ZivtbpPlkant'aC6nlfIed 0 Engine's Report (CEk) packet N. Y / No ;rm ittedssl Will tb= be fODd prep=600? Under Section: Ifso, givt appiloant a HcaIthDsPsftentbrrn. zoning Mview CaQ] not begin until we receive 2130r,04,ftm Health Supplementary regulations S%tlon; Dept. FAX DATE Circle, the ona that applies Parking Pal-king fonntfla; 7s pamol on private well o if wilt C DtMrtrjIMIt f If privatt well,.provide lit D"rtmunt form Zoning rVVIOW M not b4n until we rec'eive approval from Health Rzqulred Spam!, D:pL FAX DATZ Y/ Cirule the one am ap pj' Items to be verified in the Is PAMI on sepk ptebl even N VII) you be putfiq'up a-new sign of arty MACII If $0, ObNh, PrOPer Y will en be any risw 000madorl or rMovations? If so, obtalnfhe, Proper ?Mmit to Y I N if so, L:W' if so, List: VA '':VN 'UOOVI Rtwlsed Q CERTMCATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVI[DED TO THE LANDOWNER This form mast accompany zoning appauavons (aomw 0ewpooft, Zaenealeara=, Zoning or Appeals) Sign Permits, BuWng Pe-ro1q) Yehe application is nathe owner. I certify that notice of the applicatior4 [County application narne and number] was provided to —)M4V*1 M the owner of record of 'Nx Map [name(s) of flie record. owners of the- pwcel] and 'Parcel Number Q& /6b fAV -,gR2 - a t 2 licWton in the. by dell vering a copy of the app manner identified below., Hand delivering a copy of the -applicationto 644,-7a [Name of the record owner if the sword is a the recipient of the Tecord and the redplwfs� the oimrofrecordlsan e r1fiv, identify title or office, for that entity] Date IMHng a opy oftha VpRoa$on,to, ; [Name of the-rec-ord ovmer if the record o is a parsari if the owner ofmord is an.enthy, ideat* the recipient of th0.record and the m4plenes-dtle or of Ede for that entity]. Date [address; written notice mailed t6tha owner at the last lmown address cif tine owner-as shown on the current'Teal astate tax messineat books or oormnt real es.tiite tax assessment records satisfies p4 4 9,00/VOO'd 998[4 VA Xvpl. 'Havi qvn t . 0Z / t? L ts 0