HomeMy WebLinkAboutCLE201800007 Application 2018-01-12Application for ZonlinLy Clearance
CLE # ' �u
OFFICE USE ONLY
PLEASE REVIENV ALL 3 SHEETS Check # vl Date: . - 9 , 1
Receipt #/ Staff: -cMi.
PARCEL INFORMATION ir�rQ-tT.th�cv C�.A—Gz 4 '�-
1'ax Map and Parcel: ('�?� �- l .,xistit g onin,' 1 MC _
Parcel Owner:_�i��F�_�—�...__��]D`4
Parcel Address: I,C • � �Cif- p f t✓ State --- - !_np
(include suite or or)
PRIMARY CONTACT , ( I �Lv� " ,
Who should %%a calll(hj rite concerning this pL
prroject" Q U 1 �� i Ipj l� e
Address: � Tl l C 1� ki��l:i T —�� Cih iii, ICft{// lrnte
Office Phone: # 9�i7-yOE mail
APPLICANT INFORMATION _.
Check any that apply: ��nn Change of ownership _C hangv of u�c _ Change of name _�/ Neer business
Business ?Fame/Type: l!L �� I
Precious Business on this site �
Describe the proposed business including use, number of employees number of shifts. availahle parking spaces, number(
Vehicles. and an%- additional information that you can provide: jqQ elm
1 r i
This Clearance will onto e ;1 id on the parcel for which it is appro\ed. It you change, intensify or mo%e the use its a neu it) iir,n. a new Zoning
Clearance gill be required.
I hereby ccridy that I nwn or have the o%Nner's permission to use the space indicated on this application. 1 also cemA, that the information provided
is true and accura.., n? the hest of my knnWIcdge_ I have read the conditions of appit- . L and I understand them, and that I re ill abide by there.
KSignature—__-_-- Printed r_ 1 / -(-bin?Z
AP ROVAL INFORMATION
[ Appioved as proposed [ J Approved with conditions [ Denied
[ j B ckflolx prevention dex ice and -'or cut -rent test data needed for this site. Contact AC'SA, 977-45 11. s 117
( to physical site inspection has been done for this clearance. 7 hetef6re, it is not a determination ofcomplianct: with the existing
site plan.
[ ] This site complies with the site plan as of this date.
ones:
Building Official
Zoning Official
Other Official
Date
Date 1/11/201$
Date
C ,runtti r,f a.ihetuark• f)epartrnr-nt of C'<rnvvunit� })c� ekr}nnrnt
;(I] %Irintirc Road CItar-tuites\illc. VA 22402 Viticc: (434) ?96-EP32 Paz: (4 i4) 972-4126
Sf"Ax- FCCf me.: gat 3,�2 "
4-,?Wi 005s i r)4tqiS lou.+fon
Fin —take to Complete the folior�ing:
Y t N)
Is use m LL HI w PD)P zoning:' li ,,>o. give applicant a ('ertified
Engineer's Report (CER) packet.
�rY�l
Reviewer to complete'jfie.f0j)Q,%ti,ing:
Square footage of Use:�-
N r
rennitted as: viol esl Onci
\k'ilPmere he food preparation' I Linder Section:
If so, give applicant a Health Department form. - --
} Zoning review can not begin until we receive approval firm Health Supplementary regulations section:
Dept. FAX DATE____ 2 "L (6) C I >
CH-cle the one that applies �� ,� Parking )�uinula: l t �`-
is parcel on private hell )ulilic ,%. ►er ''I, 0, �r try l0 eB } c heY1�
If private N ell: provide flealt t Drparunent form. -—
Zoning review can not bcgin until we receive approval from Health j Required spaces:
Dept FA.I DATE __ _ --- --
Circle the one that applies 110, he verified in the field:
Is parcel on septic or&rublic s..�- e1-%ec !.
y `O 14'ill you be punirtg up a new sign of am kind`-' If ,,o, o),taui )uoper
Sign permit.
Permit #
)' r
WillPre he any nes� civhUuction rn
If gin_ obtain the proper Permit.
Permit #
4,m! ng to complete the follomilg: --
Vio � ns:
vae• c
Y N
I C'leariances_.
Inspector-:
Notes:
(late:
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SDP's
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