HomeMy WebLinkAboutCLE201600142 Application 2016-10-030
Application for Zo ing Clearance`
CLE # -
i
OFFICE U LY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: I[�
Receipt # Staff:
PARCEL INFORM
� _01q
Tax Map and Parcel: �o. I�( Existing Zonine 1 1
Parcel Owner:
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Parcel Address: City State Zip
(include suite or floor
PRIMARY CONTACT
Who should we caU/write concerning this project? William K Wright
Address : 204 E Garfield Street City Shippensburg State Pennsylvania Zip 17257
Office Phone: (__) I Cell # 5403033138 Fax # E-mail kanewright990_gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _X _Tew business
Business Name/Type: Uncle Maddio's Pizza
Previous Business on this site N/A
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: Restaurant Pizza; 25-30 employees; 2 shifts per day; 50 parking spaces
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
i hereby certify that i own or have the owner's permission to use the space indicated on this application. i also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature C.� �� Printed_ William K. Wright
AP OVAL INFORMATION
[I/Approved as proposed [ [ Approved with conditions [ J Denied
[ [ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date.
Notes:
�1
Building Official Date
V
Zoning Official Date r
Othr Offi ' 6_E�P- Date
County of AlWimarl"e Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11102/2015 Page 2 of 3
Intake to complete the following:
Y OLT,
Ts HI or PDIP zoning? If so, give applicant a Certified
Report (CER) packet.
4 YM there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not bewin until receive approval from Health
Dept. FAN -DATE
Circle the one that applies
Is parcel on private well or p;unti
e wat
If private well, provide Healtment form.
Zoning review can not begin we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or p lic sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
pN
l there be any new construction or renovations?
f so, obtain the per Permit.
Permit # `
Zoning to com lete the following:
Reviewer tb complete the following:
Square footage of Use: - ` 5"5 0
Y N e e bt l
rmitted as t Under Section: A .5 MLEf .Fide A
Supplementary regulations section: D,qtMlOMW-
Parking formula:
Required spaces: 1�
Y
Tte N +
o be verified in the field:
Inspector • Date:
Notes:
viol
YI[V
If so, st:
ffers:
IN
f so, List:
Variance:
YIN
If so, List:
SYS:
YIN
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3