HomeMy WebLinkAboutCLE201300189 Legacy Document 2013-09-13u
ti'';''
Application for F ` ,� k J F Ems%
CLE
V
O. rlcr S I N' 7C v �>
a S Date:
PLEASE REVIEW ALL 3 SHEETS
Chock#
Receipt # ^ Staff: U'f
PARCEL INFORIMA TI N,
°66'6o —OFQ60
Tnx Map a nil Pa rcel; ic�;stingzoning
Parcel owner: 'fi LQ'f? 'S C hoot.
SAM M11YZ h QI-MO}'%MIC 2Z b
Pm:cel Address: U'Q0 2 2. i Clty State Zip
(include suite or floor)
PRIMARY CONTACT
'Who Yj
should we caWwrite concerning this project? f
t) ) /
Address: l00 50,muAj NILyLODP City Gladb )(�� state V zip
Office Phone; (_) Cell # � 12 r '" Fax # E'mnil , f Lt°1.- � Mr ►
APPLICANL T INFORMATION
Checit nny that apply: Change of ownership Chat►ge of Ilse ,k—change of name New business
Business Nan►e/ ype; 4g 1�t too—
Previous Business on this site
Describe the proposed business including use, number of emplo i , uurn�at f shifts, :tvatiable parking spaces, nuntbor of
vehicles, n d any additional lnformnfion thnt you can provide:
*This Clearance will only be valid on the paivel for which it is approved, if you change, intonsify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I of o have the olamees percussion to use the space utdioated on this application. I also certify that the information provided
is tau and accurate to a est ofmy knowledof, I have read the conditions of approval, and I understand i�heni, and that I will abide by them.
Signature f,%l r.✓� --� Printed pcwlY (A �J��C -
APPROVAL INFORMATION
Approved as proposed [ j Approved tivith conditions [ l Denied
[ j Backflow prevention device andlor current test data needed for ties site. Contact ACSA, 977 -45i 1, x117.
[ ]No physical site iuspection has been done for this clearance. Therefore, it is not a determination of compliance frith die existing
site plan.
[ J This site complies with the site plan as of this date.
dotes;
Building Official �. �^ Df►tej
Zouiug Official Date
Other Official Date
County qf Albemnrle Department of CotulnunityDevelo, r►nent
401 McIntire Road,ChirlottesvWe, VA 22902 Voice: (434) 296 -5832 Fax; (434) 972••4126
Revised 711/20I1 Page 2 of
7OL
Intake to complete the following:
YO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant. a Certified
i' / N
Will there 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 411111,13
Circle the one that222111es
Is parcel o rivate wel r public water?
If private we , provr e Health Department form.
Zoning review- can not begun until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel or ,•eptic• or public sewer?
Y / 1O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will Here be any new constriction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /o
&/N
Permitted as: Xez—, 46 j2arr,:rJ
Under Section: %'K
Supplementary regulations section:
Parking formula:
Required spaces:
Y/C
Items to be verified in the field:
Iuspector : Date:
Notes:
Violations:
Y/V)
If so, nst:
Proffers:
Y /()
If so, List:
Variance:
Y /�I
If so, List:
SP's:
(�) /N
]'f so, List:
9 ! 22
Clearances:
SDP's
20 f 2—V 3y
Revised 7 /1/2011 Page 3 of 3
H.
w
w
28'8"
Double - teamer
ce Machine °o Convection
c
-, CAI
? Oven —
_- . Hood qy�;I,pm
Table
168"
Work Table with Pot Rack
Z�l
.,- _,� }, fer +: � � - 77n:'.P .:+i., alt+,-.+ is .... ,,,. .. .t f?;r• _ ,___._ _
Work Table
r
In 1 [
......... .. '
In
O1
a
O i
q ;
-I. I, API
�helvin �•.___... _
9
ii
Shelving
kelving
n _
ta= H =ot- i n=9" Workjpbe,, g t Cabinet'
N
Dumb Waiter elvin g _ ,
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name and riuniber]
7
was provided to the owner of record of Tax Map
[nanie(s) of the recur ters of the parcel]
and Parcel Nrunber f400 to ¢yjU z&a —z�c14 by delivering a copy of the application in the
manner identified Belo i jLi�o �S1/ /G� j d�i�o?o7%
Hand delivering a copy of the application to �L'Y��L� � 2suy� i2i �; 2L=r —rC LO FYYL�tQ
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
Oil 0 0 13
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
On
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as shown on
the crurerit real estate tax assessment books or ciuTent real estate tax assessment records satisfies
this requirement].
Signature of 'cant
Print Applicant Name
as /5; 11,3
Date