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HomeMy WebLinkAboutCLE201500255 Application 2015-12-17Awolleatin.m... fft'41flr- 0111 nee CLE # _aC) J� aS 0- PLEASE REWEW ALL 3 METS OFFICS, USE O Y Check # r W5 Date: P.2ceipt # .� btalY PARCEL INFO A Oil F _, Tarr Map Parcel• � (p � and f tslsting Zoning_L Parcel Owner,' wner: �p Parcel Address: F'CLe- Gd Cid C 4 �b #� Stzstc zip D (include suite or liodr) PRIMARY CONTACT f Who should we cltW write emmelnirg this project? Address : ILh4_ bf16!l City (2021ku .I I e- Statedap5Lv-� Office Phone: 3 6 Cell # Fax # 9 E-mail m- c-4na ea Idn C p AN3'LIC:ANT yNif!!LL iY _UN Z, - Chock any that aply; Chan cif ownership change of use Change of rtame Ne�v�busi-ess i3nsieess Namef dype:ki & --1 3[ " c Previous Business on this sife„_ .R0139 i LR...__. W—C _ Describe the proposed business including use, number of employees, number of shifts, available pa"g spaces, number of vehicles andmn additional formation that you can provide: E'ew -S t- FrZ -- 'Ibis Clearance will only be YMd on the parcel for which, it is approved, if you change, intensify or trhave the use to a Dew location, a new 2onuyg Clearance will be required. I hereby certify that I own wrer's permission to use the space indicated on this applioation. I also certiFy that the information provided is true and e f y owledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printtd_ A.PMOVAL ITWORMATION Approved as proposed [ ] Approved with conditions L ] Denied ] Backflow prevention device and/or current tit data needed for this site. Contact ACSA, 9774511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. I ] This site complies with the site plan u ofthis date. Notes; Building Offleial _ Date _1_)—_I_ c IL Zoning Official Daae _ --_-- _ _ X ?-e914; Other OffEcia Date Courtly of Albemarle IDepartmeat of Community Development 401 McIntire Ilmd Charlottwviiie, Via 22902 Voice: (434) 2%-W2 Fax: (434) 9724126 Revised 11/1/2015 Page 2 of 3 Irtalse to complete the follow!ng: Y) / N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y6 Will there be fond preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE _ — Circle the one that applies Is parcel on private w or public ter? If private well, provide arttnent form. Zoning review can not begin until we receive approval from HoWth Dept. FAX DATE Circle the one thatappli Is parcel on septic o Me seine Y / IST Will you be putting up a new sign of any hind? Sign permit. Permit # Reviewer to comple g—. Square footage of Use: Z] gam #ea as: 14"atq,. 1aj'L,4X1e, -QgS Under Section' fit; Supplementary regulations section: Parking formula: / 1 / C sq,1 v Required spaces: 7 Y/N Items to be verified in the field: If so, obtain proper I .-... �•--�-- ---.--- Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the f©llowine: inspector : Date: Notes: V1011firs. YIN If so, : Prof ers°: (j/N Vari e: Y/I If so, List: SP YI' If so"Ifist. Clea maces: SDP's Revised 11 AM 15 Page 3 bf 3