HomeMy WebLinkAboutCLE201300205 Legacy Document 2013-09-18•�3;
Application for Zoning Clearance t
PLEASE REVIEW ALL 3 SHEETS
OFF[CR Y
Check# Date:
h
Receipt# Staff:
PARCEL INFORMATION
Tax Map xmdPmred: 14500 0C3 °'y' ° l aGi CU F. 974n
Parcel Owner: N A DOJa QL-Q,� V- p6 S'Q)C- Cui
Pared Address: (110 r a zlpqj "bt
.,city
(kciade suite or floor) .S(
PRIMARY CONTACT C
�` ox
1 �X
Who should we OdMrfte concerning tbss prS*V I� C t" SI
Address O - fa .� . � w � � � - � G'Y`GG � ���. state A)C-- Zjp:.7 dpq
O!fficePhone: i( 51,1 0) -- jg00 CeS# Fax #:�1�
APPLICANT INFORMATION
Cheek any that apply: Qlange of ffimersidp huge of use Cltatge nuts bushtess
Business N=wType:
revie us Buskers on this site C�
Describe the proposed bvauess indnding use, number of employees, number of shifts, lv"- �r3dn sic s, number of
r S
vdddes, and au Addifian``aL-buformadEon that au can provide: e- 1,4v-e—
*INS Clearance will odybe valid on $za Parcel for winch itis nyrov-ed. Ifyou cite, udensifyor nio,"t disuse to anew location, a umz6ain
Clawwwo will be reVired.
I bcrebycatifp d:sEl owner b'ec the MwesPelmission
I Lave ssad tlxe eon iiansiadicsbed � andItbiodec ndtbcm, wad tdr a ji bbyy*ma
is lure wad mcaraie to dw bcst ofmyknovvicd$e d,
' j Printed I� " i �
Si aabtre
A PROVA►L INI' TION Denied
[ Approved as proposed E 7 Aiplo� v*b editions E 7
E 7 Ba"oarp v"Stion &vice and/or cxureat test data needed forthk site. Contact ACSA, 977 -4511, x117.
E 7 No physical site inspectiion bas been done for this clearance. Therefore, it is not a detezminat ion of compliance with the exi dutg
site plan.
[ ] IU site complies vd& the she plat as efthis date.
Notes: -
Official Date
Banding
c�
Ming Official Date
Other Offidal Date
_e n_.._...s..S�.r ifavdnwxoaamfi
401 McIntire Road Chniettesville, VA 22982 Voice: OU) 216 -5832 Fa= (434) 9734126
Revised 7Cii2011 Page 2 of 3
Intake to complete the following Reviewer to complete the following.
Yf
Is u LI; ffi arPDiP zonarg? ifso, dive applicaai a Certdred
Etyineees Rqtont (CFR) packet
Y
'Will ere be food preparation?
If so, give applicant a Heahh Depatdment for.
Zoning review can not begin until we receive approval frown Health
Dept. FAXDATE
Circle the cane that applies
Is parcel on prhaft wrll or public water?
If private welt, provide Heakh Depattmmrt form.
Zoning review can not begin until we receive approval from Healflr
Dept, FAXDATE
Circle the one that applies
Is parcel on septic orpubl€c sewer?
Y
w' yonn be patting up anew sin of way kind? If so, obtain proper
Sign permit
Permit##
Y
LV' ere be wary new cans6vctian orreuovrtione?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following.
SwarefootageofUs+e 1 OV Lh
'4nifted ow -
T
Supplementary regulations section:
Required spaces:
/(N�
It be verified in the field:
VIO
Y!N
If
PreAesS:
Y/N
YfN
m�
I
yn
Clearances:
MPS
U
Revised MA011 Page 3 of 3
Ir r' FFrfr r+ 7 rr; .r�!�l {. � ,/ ♦ ?r, r4- M
I �Y ihai notice of the application, �' � ��•�� �1-� � o ='� �' � -� � � d —� n
[County application game add nu nber]
was provided to ' �4 0A YL pao `Gil e� w�-�ie a�cvnea of recarci of Tax Map
jnam*) of the mmd owners of the parcel]
'"
and Parcel Nmnbra• ° V"t� ° Q:�' �dky delis a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the oNm of record is an entity, identify thereapie t of the re=d and the reripiats
tide or office for that entity]
,I
Date
bailing a copy of the application we &I C) Acce S
[Name of the reed owner if the record ownntr is a person;
if UMOMWdrecordism effity, identify theredpient of the record and therecipieWsHear
Off ice for that entity)
on - 9 — Z C! — ) ?_> to the following addrm
Date
X11 c.er \1 A o-)d P-qI)
[address; written notice m&UW to the owner at the last knovin address of the owner as shown on
the current veal estate fax assessand books or amrent real cM to twc asses records saftsfies
this requ mmaj.
,el/ ` ��e
Signature of
Print Applic�dt
10,6"
THE BARRY BUILDING
2019 Woodbrook Court
1481 sqft
. ...... . ..... . ..
SUITE # 2
SUITE # 3
SUITE # 4
SUITE # 1
---- - - - - -- - - -
3C)80
JAN.
CTi-
�
3080 5OArooerl
OrFkr—C
Recent
SUITE # 5
3080