HomeMy WebLinkAboutCLE200600003 Legacy Document 2014-06-2002/14/2006 16:26 b'AI 434 972 6221
n Bing CIearance = 835
PLEASE RENEW ALL 3 SMETS
"�• ;EL INFORMATION
Environmental Health
4 ALB Bldg Insp 0 001
OFFXCI; USX ONLY
CLE# '2,0eU - 00003
Check # O —
ReceYpt Staff:
'ax.Map and Parcel: —7 Q(]7^� — 06 005-EO Existb,- Zonin.gl Ag c-- 1, k. ay Co rrl M,0j0 COQ
' arcel Owner:
area'Addres3:__ �3� 1 •`yi-o7'i PC),) N Ib( City _ - State Zip
_,, (inlcttncde suite or_Lfoor) - ------ - --
XPLICANTI�NFORMATION - --- ---- ------- --------------------- ----------------- --------------------
---
Vho should we ealVwrite conearrriiug this project?
-�-t i i ger V f ; 4 i4') City �a� c r state _14k Zip .0 6l
Uce'Phone; ("3 49-) � 4-15!5; Cen #
MARCcoivTACT�________ ------_ �--------- _-------- .----------- - - - - -- ------------------------ �- ...._.. - - - - --
tis(raees
rovious )Business on this siite-
�,
if applicable): -�Firewarks / Christmas Tree
yC..
_E,-CON )XTiONS O)? APPRO'V'AL iF TaE CLEARANCE x5 FOR p'MEWORK o�
TIME SALES (Sheet 1)
his Clearance wM only be valid on tine parcel for which it is approved. If You ehahgc, intensify or move the 'use to a new location, anew Zonitlg
eatancc V01 be required,
os cby cettilgl own or have the owner's permission to use the space indicated on this application. I also certify that the infbrmadah provided is
e'and accu to a best of my Imowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
.nisbarc Printed 10 S % °) � C�
0, r
OVAL MORMAT�zON ---------------- - - - - -- -------------- _....... ......... _..- ......._....__....
ppro'ved 8 proposed Approved with conditions
fiNo,physical site inspection has beta done for this clearance. Therefort, it is not a deramination of compliance with the existing
,plan,
} This site complies with t6 site plan as of it is date.
rdding Oli6cial
Date
k1dikg; Olnci,Ia?y. Date
;� --��1' �` �' � �►�"rN '�� Date / ' �- y.�
- ----------------------- -.- ............... ... _.... - --
Cotmty of .Albemarle Department of Community Development
401 McIntire Road Charlottesy&, V'A 22902 Voice; (434) 296 -5832 Pal: (434) 972 -4126
inn /Inna wdai -nn annr 9 URr A7LV7.1ft£t/ X124 LIWWAPA'-In k iwnWWn�
02/14/2006 16:26 FAX 434 972 6221
r4vc rnae of the following?
Environmental Health i ALB Blds Insp Z002
,rax Map and Parcel Nurnbcr and or,
`p dress bfuse (include unit or floor if appropriate;
Do you have a Floor Plan (sketch or an architectural drawing) that
6pp�4ucs the following, and if so please provide it witb the
�afion?
rhe: total. square footage of the use and/or,
ilie sgaare footage -of each room or area of use;
:Tse of each room or area
f usb° less than the entire stru=e, note the location within the
,u•w.41� l.. �l�
• T�
Y (N
Xs nse in LL M or PDIP zoning? if so, give applicant a Certified
Engineers Report (CER) packet
Y�
Will there be food preparation?
If so, giV- applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept, FAX DATE
TS parcel on private well acrd snptlo ?L
If so, give applicant a Health DoparaA';ntform. �S
Zoning review car; not begin until we receive approval froln
Health )Dept. FAX DAT - �i �D
Is on public water and Sewer?
t5�A —
Q��
L'1_j
,_Sp, ul eA
Tech to compete the foUowinp�`
Witions: -
:/N
SO, List
rl*pce:
o; Dist:
rrollers:
Y/N
If so, List
SP's:
Y/N
If so, List,
Y N
�-
llyon be putti c-g up a new sign of any land? If sa, obtain
oper Sign permit,
FPP
rmit #
Y
,a
L�
will there be any near cor:structicM or nenovatio US.
�
7LIA
If so, obtain the proper Pamit
Permit #
4.Z. "'
N ,
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit
r
Permit #
Tech to compete the foUowinp�`
Witions: -
:/N
SO, List
rl*pce:
o; Dist:
rrollers:
Y/N
If so, List
SP's:
Y/N
If so, List,