HomeMy WebLinkAboutCLE201600099 Application 2016-05-02Aknplk l ion for" G 0e'" IMI.0
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PLEASE REVIEW ALL 3 SHEETS
Cheri
Receipt
PA "EL INFORMATION
T�•: �:��r. ���a raurca: �� 15c. - a®- o � � �.�
Pared owner: Kio U)eS± r'S
Hats:
staff! �rsC
Existing zquineLli tay_P I Vn.+-
Pared Address: 3 07 L ..% Rio FLh City kar% Hzsv_" Z L_ Stale V'+ ��
(include suite or flae:r) p
Who should we call/write concerning this pry eaet? ��•� ��� ��' �' a �c ti I
Address :.3 07 A- P- ._ CityC l i�a�� State_VA
Office Phone- % 21.i - 7Wr � S'' Ccu fl __- Fat ti q V-04, 7S E-mail
G
Check any that apply: Change of M. misip _ -. ]Change of Use GbN%C ofttamt � 1Vew l�rt,ittess
Rursiness Namefl'ype: _Tuc_ke4- Gr-r-F-RA Be, rryeS P• <^ , - . .
prvvioau IE iUeam ®n this slBe
Docribe the proposed business including um cumber artrmploycea, nuraber of shift available pariting stpacts, number of
vehdcdes and any additional krormation that you ca)m provides . [�� o r"pYt s �u
"Via Clearince will only be valid or, the parml for winds nt is award ifyou ehande, ij3Irn� move Ill. use is it new tomb Win, 4 new zotMn
t'icaesmsx will br rzcpli t.
I hereby cmi3"y that I or have the owner's permisaban to use the spare indicated on No appIi **11. I also certify that tax; ipfotmaliav provided
is true aid accurate to the best of left. l have and the oundiWns ofapprovat, and I undors=d. them, and that I will abide dry UMM
Sl Approved et pnaposM approved with conditions [ ] Denied
[ j Elacktiow prevention device andlor current last data needed for this site, Contact ACSA, 9774511, x 117.
j No physical site inspection alas beam done forthis cloerance. 11arrel'ore, it is not a determination of compliwme with the cxisang
site plan.
( ) This site complies wM the site plan as ofthis date.
Water.
Building Official Deft
Zoning Of d, Hate
Ot`er Offta1 _:..._ _ Elate
County of. biu..u.; _ �ye Deparim"d of Community Development w .
401 Mclatire Read Charlottesville, VA 22902 Voice: (434) 296-5932 Fax. tz,134) �';: •w9�'�
Revised I l/b7O15 Page 2 00
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CERTIFICATION TION THAT NOTICE, OF THE
A ' ICATIGN HAS BEEN � ROVEDED TO THE LANDOWNERThi. � ntrnrrts! uccar ro r zoning Owapation, Zoning Cearance, Zawng
Admbdstrator Deferadna4ons orAppeaj% Stigr.. Bail Ng Aarmits) tfthe ap'Phe Lion a rant the
owner.
nn: iii "'a"i m ofthe application, _
[Cnunty application name and number)
was provided to RL b W e5T G Ua 54 H-r P r trr; ,L.a•n of record ofTax Map
[naane(s) ofthe record owner of the pamelj
and FftW Number06t k/ —Od—W-00 a?o ---by delivering a copy ofthe application In the
manner identified below:
Hand delivering s copy of the application to � t4 a f!* ✓ _
[1`+Imne of the record owner i the mord owner is a
person; if the owner ofrecard is an entity, ideiitify the recipient ofthe rerttrd said the recipient's
title or office for tW entity]
on 3 J3 o IZV [,,
Date
Mailing acopy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on to the following address:
Date
[address; written notice mailed to the owner att the la , r,mvi idnixess offt owner as shown on
the current real estate tax assessment books or current real estaLC iax asseSVnent records satisfies
this rrequirementj.
Signature of Applicant
Mat ApplicarrtName
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