HomeMy WebLinkAboutCLE200700143 Legacy Document 2013-12-30Zones Clearance --
OFFICE UM ONLY
9 zo�tin Clearance = $35 M # -zoo
PLEASE REVWW ALL 3 SHEETS Cbeck # Date: - -0 %
Receipt# to 's em st
Tax Map and Parcel:
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Parcel Owner:
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Parcel Address :�� City e //.cry _ State �/� Zap
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PRDURY CONT A Cr
Who should we call/write concerning this project?
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Address :� �,r'��o,• �lx stage 44¢
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Office Phone: ( j �� CeU # >6e- fJJL3 Fax.# E-
APPLICANT WORM .'I'IQN
)ansbms xameq ype: 4l &oa
Pre'c'ious Business ant this site Jd.7 r--
Describe t1te proposed business, iAcludiog usp, number of employees, number of d0ts, avallable
addWond b4oxoa,ation tb,at you can provide: iJl F_ ,r1r --ye e*og*/�..s f- B�
spaces aJt1,d: salt'
*11vs 0mrance will only be valid on the parml for wbich it is approved. If you change, intensify or cove the me to anew location, a uew zonimg
C.lowannom wiU be "uired.
I Jxereby certify that I own or have the owner's permission to we the space indi d on this appli ,cation. I also catiiy that the i;tforWadon provided
is true and ao=atc to to boot of my AXtoivledge. I have read the conditbw of apinovai, and I uudez� them, and that I wM abide by them.
5igiature ��e!�Cs Pzduted 0oe-falLr.<
APP OVAL L%TFOR iA T ON
[ .�9 pproved as proposed [ ] Approved with :conditions [ J Denied
[,PadUow prowntion device sudlor cumat test data needed for this sits. Contact AGSA, 977-45 11, x1 19.
[ � o physic d site inspection bas been done for tbia ojewmre. Therefore, it is not a detama nation of cox) f plitauce with the existing
site plan,.
[* 1 This site complies with the site plan as of this dare. Backfiow Device and/(
19
I 111 1 79f
i
O&u Official Die
County of Al benwle DepartmeaVot Community Development
401 McIntire Road Charlottesvft, V,A:22902, Voice: (434) 296 -5332 Fax: ( ) 972412+6
511106 Page 2 of 3
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jtt a)ke to complete the following-.
Q yts IV No
Is USV in LI, HI or FDB? zoaiW, if so, gyve applicx-at a Certified
Enghieees R.epcal (CPR) packet.
❑ YBS NO
Will there be:Cood preparation?
If so, give applicant a Health Depa cent fman.
Zoning review can not begin until we receive. approval from lledffi
Dept. FAX DAA E
�
]/ YES ❑ NO
Is parcel oxi private well or bli
I£ private well, provide II Dcp form.
Zo�g review ca�pt nc�t begin . we =cive appmvsl ftom Health
Sept_ VAX DATIE
In YES ❑ NO '
Is parcol on. septro or bltc se
❑ YES ENO
Virill you be puttiug up uew sW of any kind? If so, obtain proper
sign permit
rerxrt#
❑ YES E_NO
Will there be any new construction or renovatiow?
If so, obtain the proper Pem it.
For A,r1 = - _I
Z,onme Tee ft to eOMMete the IOJLLO W1 SE*.
Reviewer to comps a trite following; \�\
Square ootago ofuse, JR2
YES ❑ O
Permitted as:
Under Section.
Supp1memtary r bons section:
Pa*.ing formul��
Reciuiro spaees_
M
C7 YES F-1 NO
item to be verified in tie Aeld-
lwpwtor Date;
Now;
Vjo1ationss
❑ yp-S P NO
If sa, I zst=
Profreiv
❑ YES 411N0
If so, List
Variance;
❑ YES '[NO
If so, List-
SF's= ;
❑ YES M NO
It so, X;bt!
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