HomeMy WebLinkAboutCLE201600230 Application 2016-10-10Application for Zonin Cleikrance
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PLEASE REVIEW ALL 3 SIMETS check L USE01k1.v Date: � O
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PARCEIL INFORMATION
Tax Map and Pamelt / (1-- 01 —db +315'OG 1l;xtatiag /.ottswz "• � - - -.� .
Pam el Orrner• L d
Pared Addressdr/b 1�hr.iw% 'T i City t'iZ' State Vj Zr w1b
(include suite or floor)
PRIMARY CONTACT
Wbe+ sbould vre ealUwrito concerning this project? tot rN A it,.,,
Addresst -rQkTK �%p _Cfty T M— State_ NC--- _ P J
office Phmc ?bS2--'Z-0061#7041-q&a r,, 0
APPLICANT Is'V URMATION
Check! that "ply: Cba of om mershi Cbeeu a of Use Clreut c of name d--Wew bmxiueso
Bushum Nonni /Type: PI c-
previous Business an this site
Describe the proposed budnen inoladirrg asq number of employm, nwatber of shUb, available psrking !plot, uaaiber of
vehidea, and any additional intornudon that you can provide;
*This Ciearanee will only be vaif d on the parcel bt whirb if is apprnvad. if You chmSe, intensify or move the —Um- to a new lmsa Q4' a new %rating
t;iowmee will bomquircd.
I hereby tmtify That I awn or hive the owner's peeaisston to use de spare indicated an"app[icadion. 1 odic teed#¢ that the lafbrtuatioa provided
is true rand svauratc io the hest of my kncwlcdgc. I have toed tic—ndidalm of approval, and t undanietad tbem, and that 1 win abide by am.
Signat�ue �'� �'' pritttsd /�Ia.-i �' �rt ..✓
APR OVAL IN)FOIiMATION
Appruved IS pMposed [ 1 Appmvcd with conditions
f j Ba&low preverition device aadlor eunwit test dada deeded fPbr this site. CoMact ACSA, 977-4511. X117,
[ No physical site inspection has been done for this clearance. Therefore, it is act a determinadca of oomplim= with the existing
sift plan.
[ ) ?his site complies with the site plan as of this date.
Nut":
BuiMing CMiml patq �&
Zoning Olt dai
0Ur Offkw pato
County of Alfaemarle DepaTnmcat of Community Devd9liment
401 Midntire Rosd Cbmi to tmille. VA 22M voice: (434) 5M Fax: (434) 9n 411i6
Rwvised 11/1/2015 page 2 00
to complete the
Y/N
Ts use InLI, U or PDIP zoning? If so, give applicant a Certified
Engine&# Report (CER) Packet:
Y /j%
WAY be food preparrttiun?
If so, give applieant a Health Department fom
Zoning review can not begin until we receive approve) Dom Health
Dept, FAX DATE
Circle the acre that applies
Is pwreel on private well or blic w
Ifprvatc well. provide Hearth attment farm.
Zoning r&Wew can riot begin until we receive approval from Hralth
NO, FAX DATE
Circle the one dot applies
Ts poral on septic tar lie stwer�
VYIN
ill you bo putting up a new sign ofany kind? If so, obtain proper
Sign permit.
Permit tl
wilwcre be Amy new consiew ion or "inovatioaa?
If so, obtain the proper Pam it.
Permit#
ZQaing to com>lete the fonowimm:
Reviewer to complete the following:
�MiNttc d as: k� �
Under Section. '2- 5�'- .�—..........
Scrpplameruary regulations section:
Parking fomula: za
,
h-
Required spaces: 1
YIN
Acmt to be V1riHed In the field:
l opector : Date.
Paum
Vialettonx
Y1
Tf so,
proffers:
c$ rN
If 10, List:
Vadenet:.
60IN
!f sn. L iat:
SP's:
N
ll10, Dist —73
t.leawces:
SDP's
DJ-
SIS
Revised I I/II2035 Page 3 bf 3
CERTIFICATION THAT NOTICE of THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
L torDWffMltil*Mar4pp t,*4 pWaIF4BreMdft nr*&*j #,lice 4ppUo*"is jW ghe
dMxer.
I ratify dint notice of the application,
[Coarrty applicttm neme and nwnber)
was provided to ed e,-k I Aeod�y the owm oftecmri of Tart hop
(name(s) of the record owners of fhe perms
VW Fail Number -- by delivering a copy of the appiicdion in the
manner identified below.
;"land delivering a copy of dw application to
[Nma of the record owner if the reeosd owner is a
person; ifthe owner of record is an antity, identify the rodpient of the word sad the recipient's
title or office for that entity]
an
DW
R�1TA1\
Mailing a copy Of the application to r't Gf$PW1. Ioeto� —
[Name of tine room owner record owner is a person;
if the owner of raced Is an entry, identify the nrlpieart of the record and the radpicnt's title or +
office for that radw
on .. Date, to the following atddrew
�—
I //7 errl h f S�-. G-%y-r 10 f4Sv.-J 1 e
[address: wri*n notice. mailed to the owner at the last bx4n addrea of the owner as slxwm on
die airrent rcal estata tax gseiarnent books or canwt near estate ibm aoie mew nmords satisdes
thla requirraneat}.
Signatom oF�kpplr'ca>tt
Print Applicant Name
Daft
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