HomeMy WebLinkAboutCLE201400097 Legacy Document 2014-06-02Application for ZO.ning Clearance �a.
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PLBASE RE VIEW ALL 3 SHEETS
PARCEL INFORMATI nI
T xi }�ltipandParcei:_ __..�
Pareel Owner. (Z 4 Y
Crsecic # Drttu
Itet:rJpt # �ta.r'p fYti��
xisCtng rr � _
Partt-lAddrm'. Y 7 _ Cil:y: tt + Stntc zip 1�t"
(rncrt Je suite or flour)
Fl2iMARY CONTACT
4 N) should we calthy rite wimerning this project" - . CO L C Ci? 61
Address; "i3 cite ' ' -t state. ;ZIP 22 -Y
APPLI CANT INFORMATION
Check a that tt }s i y ne o, WY 'Ut
Bminess Ns,mel'ype M4, '' 7`.
Previous Busincs$ on: this site,
Dzseribe tht" fir ►post~tl ttttsin s. in udikt ttp tt tttiser fetttpCa ecs, Stu iter al siJIU, avallahJts. nridnp; spat~ta, number of
xr les, mid an additional inform.atitra that You raxa provide- -75 Fe-kr
Ow-rantx till In required':,
! ��. c�rasi6y tlast i s��: tz. l�n
ii Inn ie. tz" Earl G
5i,gttatu
f. k- & _ , 1. 41 LZ
don r e potter for which it is appmmL Irytast d1341flnienAry Ormovi tJto Uso:to a nzw I,omion, AzewZoning:
r t'e ca apex' petsn crnas to s the Sp i dlC� .. 4u t.1is pprii iirrn. I . ify first tb irsCarra agora rartavideci
my i no- **9etizC J have trust the c owiflons of naval, and t 'ur a tad thm and tail shit ar ldc by t3` tm
Prima
County, of Albemarle is ieparintcrttofOummulnity oevelopruetst
40 1, McIntire hand' Chart u.ttcOIlle-, VA ZZ902'Voice: (434) 296 -58321 m (434) 971 -4126
avised 7/j/2011 .Palm 2. ¢f3
102ke toz Complete the f6llo wt`ttg:
Y I IINT
Is un an IBC, Ht or PDIF zanlnSy lfso., give applicant ra certified'
Enginates RcpoTt (CER) pnckoC
V r
VJH_ .. be 1botl iar3nratibn.
tfsorgive applicant a Health Dooxi nicaat form.
Zoning review C-,An riot belin Until ova rraeive approval from H Cal III
Dept. COAX DATE
Circle the Ono that npplics
Is parcel on privAte Is, -ell or 0110 %yate
If privale well, pmvf de deal ent frond.
2orirag mviiewrarenot begin until we roe;civc approval from Hufth
Dept~ PAS:: DATE
Circle the one the ap
Is pared on: septi r l ttbtic sewcra
YJ.
� Al apaattiaag upa anew RDA ofcant find i so, calatnrn la per
Sign permit.
Permit 0
I
'►ail hl. ere be On new construction or rciuttvations7'
efso, obtain the proper Perm'
S�ppCcaa,tnt�tty re�ulntogas sextrtarti
Parking formttlw �!
� �ti xlo
Zoning to complete the followin
+dia7�aivns
�off�crs:
'Tit 1. f sta ist;.
so, List-
Variance-
I
y
Ifs tStt
Irst},List,
SDPIs
..........._
Cteaa lances,
Rev sed 7!'tM II Pager of3
CE RTincxriON THAT NOTICE OF THE,
APPLICATION AS BEEN PROVIDED TO "= LA"OWNER
Thisforin Must acconipany zonhig'a'a
'Plicallogs (170111v Occupation, Zoning Ckarance) Zoning
Administrator Determinellons OrAppe*, Sign perinlix, .uniting pattlits) j0he applicalla'" is nalhe
01.1410. 1
I certify that notite of the application
[County app I ication nave and number]'
was provided to th a owner of record 01"Tax Map
(nam4s) of the recor
. A owners of the parcell
and Parcet'Nurnber --by delivering as copy of the 8PP111ca lion ;irk r4r,
manxt identified below.
Hand delivering a copy of the application to
[Name of the record owner if the reto
rd owner is a
person; if the owner of rocord is an entity I'd entif 1PI
title or office that entity.;
on
Date
laddress; written notice mailed to the owner at the lastknown address of the owntr as shown on
the Current read' estate tax Wessment books *r curmnt real Wote tax assem. ent-rcoords.satisfi=
this requirement],
Signature of AWicant
Print Applicant: Name
Dtrte
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I 1 ,
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0 C71
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