HomeMy WebLinkAboutCLE200700187 Legacy Document 2014-01-22000
Application for 0j
Zoning Clearance ,
OFFICE USE ONLY r P V
Zoning Clearance = $35 CLE # � V / 7
PLEASE REVIEW ALL 3 SHEETS Check # _ Date: _ '7 —
Receipt # Staff -
PARCEL INFORMATION
Tax Map and ParVI: ✓ /� / ✓ !¢2L'��� Existing Zoning T
Parcel
Parcel
(include suite or floor)
PRIMARY CONTACT /
Who should we call/write concerning this project ? / c
Address: =k "f ee:. �#// City
Office Phone: 'Ez :: Cell # Fax
APPLICANT INF
Business Name/Type:
Previous Business on this
Describe the proposed business, Including use,
additionalynformation that you can provide:
�- �L
/t/z /770.V,6 State — Zi
E -malt ��c'/fGG/r /7GC2if2 s�G
�l r} /c/b W1167111
number of shifts,
spaces
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, d I understand them, and that 1 will abide by them.
Signature %lac- �___ Printed
APPROVAL INFORMATION
ftol'Approved as proposed [ ] Approved with conditions Baf 2 %APViCe and /or
[ ] Bacldlow prevention device and/or current test data needed for this site. Contact ACSA, 7�9NkTeSt Data Needed
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a dete nee itQt>Lc� yvjtl�e>s�i��
site plan.
[ ] Ibis site complies with the site plan as of this date.
Notes:
Building Official " Date
Zoning Official Date 0-7
Other Official
Post -its Fax No e 7671
DateQ a�
pages►
T
Froni
Co. /Dept.
Co.
Phone #
Phone #
Fax# ,3 r9a27
Fax#
Date
*ar-tme ommunity Development
VA 22902 Voice: (434) 296 =5832 Fag: (434) 9724126
5/1106 Page '2 of 3
Intake to complete the following:
❑ YES ;] NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES V1 NO
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
❑ YES ❑ NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic r public ewer?
F-1 YES ❑NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Iii- t
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Per 't.
Permit #
Zoning Tech to complete the following:
Reviewer to complete the following:
Square ootage of Use: t�6_8 V
YES ❑ LaA � k 6&, , (T) n?— �, oasj
Permitted as:
Under Section:
Supplementary regulations section:
Parking fo t Ito (J-
Required spaces: ,
❑ YES M NO
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
❑ YES ['NO
If so, List:
Proffers:
❑ YES NO
If so, List:
Variance:
El YES �NO
If so, List:
SP's:
❑ YES (1NO
If so, List:
511106 Page 3 of 3