HomeMy WebLinkAboutCLE201400216 Legacy Document 2014-11-14ktofi�E
"unt y ®II Albeanaide Department of Communkv Developlijenj .
401 IMICYntire Road cCha rRottesvnllle, VA 22902• Voiice. •(434) 24 -5832 F..- (434) P72 -41126
Revised 7/1/2011 Page 2 of 3
Inc,
' CJiJJL't /mod./ 1. 1 '� L.-
`f �✓ L
REVIEW ALL 3 SIMETS
OFFICE USE 5Y
Check #
� � Date:
i8a°cieilpt krfu,. Staff.., .
PARCEL M(DR AATXCN .
Tay Map and Parcel- C) Exis rng zoniup,
Parcell Owner: i I SO Yl1
Y'ara`e➢ Aalldress: f t 5 htrcrc� - I • iV IC Mcky l statc Zip � cJ
,roZ4
(include. suite on
PR MARY CONTACT 1, r ,— . ,
W1 'o shouRd we calld(�waste, concemmi a thh progect� �' � �
i
Address: 5` �� -hif 1- ;I Ln city C �i 1 �le�t to -
Z7,np
Oi ace l�t�otmea �_ Cell P ` 3l oa @�
APIlnLU CANT I Nj OMYIAff0N
Check any that appIlyo change of.0imership (Change og nuke El;hat�g� oft naffing New, Ibunsiuess
_ Bns3YC33NaBQ%�peo d .p AYI%
pre_Ao, ns fts*955 (DID this site � � 7� f s ,J_
I(Descri .e the proposed business inchiding apse, nnim beroff employees number m ghiffts, awailable pan mag spaces, npupnalsea of .
➢nicll �, affi@� any a min4a® ail IlmpaIDa 'In 1112t y ®nn prS➢vJtd�lea (( t'
*This Clearance -Mll only be valid on c for which it is approved. Ifyozi change, intensify or move the use to a new location, a n:ew Zoning
Clearance will be, required.
I hereby certify th or ve the o �� s ?emission to use the space indicated on this application. I also cenfy that the inf6nnation provided
is true and cc a b t of my' oAedge, I have read the conditions of approval, and 1understand them; ;and that I will abide by them.
Sigana e fainted i Il E s �l �1 �`� a ll���'�ig} A t'lL
A fi L IINF Oit�IATIMN
pppoved as proposed • [ j Approved With conditions Denied
['I Bacddlow prevention device ,and/or current test data needed for this site., Contact ACSA, 977 -4511, x117.
Q No physical site inspection bas been done for this cle ce: Therefote, it is not determination of compliance with the existing
site plan.
This, si a complies wi the site as of this: date.
Notes: Ii MA
Building (Off-ReW )IDate
/Zoniung(tincia➢ llyate li
other Off icia9 Date
"unt y ®II Albeanaide Department of Communkv Developlijenj .
401 IMICYntire Road cCha rRottesvnllle, VA 22902• Voiice. •(434) 24 -5832 F..- (434) P72 -41126
Revised 7/1/2011 Page 2 of 3
Inc,
nt.%ke te- COMPRete the TORBO dffng o..
Reviewer tan c omPlite tribe TORRO k
Y. /
Is us . . LI; M ox PDIP zoning? Iif so. give applicant a.CerfifieiIl .
Engineer's Report (CEP.) packet-
Will fi ere be food pre aration?
p
Square footage of Ilse: .
N
- e��nitted as: pp��
' l C't,�n
Uhdie- Secti n: ('
If so, give applicant a Health Department form.
Y N
Zoning review can not begin until we receive approval from Health
Dept. FAX llDATIE
Supplementary regulations section:
Circle the one that applies
Is parcel on private wellIl or ltaYee water?
ParlQng formula:
If private well, provide He ent farm.
Zoning review can not begin until we,receive approval from Health
Dept. FAX BAICIE
Required. spaces: �
, '
Circle the one that app
Is garcel on seoptne r dMe seweir?
Y/N
Iteriw be veered "in the'Reld:
A
Y/N
o
Will you be putting, up a new sign of any Rd? If so obtain groper
Sigh permit.
s 's e
Vermit #
Ilmsp�e uu o IDatet
Y / N
Notes:
n or renovations ?.
Will there be any he/61-
If so, obtain the PK6
Permit # .
z9a mg to CO&TORette.the ff®llRO -TIA ng-o
ViuIlaii ®ruse
fferso
y
Y N
If so, List:
so, List:
o
s 's e
7�Y�°aQICi��
7G1Jt
. if 5o
'?
(CIleau�mee s>
SDP's
Revised 7/1/2011 .Page 3 of 3
CERTM (CAT`10N THAT NOTICE 9F THE
APPLICATION HAS BEEN.-PROVIDED- ED• TO . E LANDOWNER
278is form must acc®rnpany zoning, appicatnons (Home Occupation, Zoning Gear°ance, -zoning
Adr,ginas'�°ator° IlDeterminadoras OFAppeeais, Saga Perm ts, Buaidjaag permms) tike application is not the
owner.
I certify that notice of the a' pplicairion; i
j [County. application name and number
w s provided to n W 1 J� ✓ the owner of record of Tax Map .
[name(s) of the record owners of the parcel]
and ]parcel Number o 5 ,5G0. -1 -M •- ( C (� . by delivering a copy of the application in the
manner i ntified below: `
l'fand,delmvering a,copy of tae application
to 0'
[Name of the • ecord o��mer if the record owner is a,
persorij if the owl • wine r. Y�Td iS an entity id�tifythe Pact pient of the record 8nd the recipient's
title or office for tat entity]
.omfl
(Date
Ylailing a. copy ofthe application to
[Name of the record owner, if the record owner is a person;
if fP't2 o1li9mr of rewf is 8n e fity, 6dehtify tVS r'd pieht of the rEC cd 'd a3 d th6 Peci pi ent'S titf e or
office for that entity]
on to the, following address:
Date
[address; written notice mailed to,the owner at the last known address ofthe owner as shower on
the cumrent real estate tax assesMent hooks or current real estate tax assessment ords satisfies
this requireanent].
• r'^
Signature of Applicant
Re's icy
Print-Applicant Name T
LNDate
EMM
5K Course Directions
Start on Claremont Lane.
W gaze bo in front of "The Lodge" at Old Trail)
Turn :right. on Old Trail Drive.
00.t ..past the pool)
Leave sidewalk, right, on pathway
crossing soccer field.
Right on Brookview.
Lefton Summerford. .
Lefton Hampstead:
left on Grassdale.
Right on Wellbourne.
Lefton Old Trail Drive.
Right on. Golf Drive.
Left on Nature Trail.
Left on.01d Trail Drive
Right on Glen Valle Drive.
Left on Claremont Lane.
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