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Home My WebLink About027-94 Minute Wok - Shawnee - Backfile (2)* STAFF SITE PLAN CHECKLIST * This application is not complete if the following are not included: -oK- 101r7ls4- One set of comment sheets from the following agencies along with any marked copies of the plan; . VDOT N A LCanitation Authority OK- 9 /I I94 •Inspections Dept. oK' 911 L194 -Fire Marshal oK - 10113 19+ -County Engineer Airport Authority - oK' 8131h+ �ity of Winchester Imo''; 2. One copy of the Site Plan application. Y 3. Five copies of the Site Plan. 4. One reproducible copy of the Site Plan (if required). 5. One 35mm. slide of the Site Plan (if required). TRACKING Date L i,,Application received. All necessary agency comments received. Fee Paid (amount --^C Site Plan to Planning Commission via bi-monthly. Site Plan heard by Planning Commission (if required). Revisions received (if required). 16 X-n *te of approval. n added to to e. tau s - f Town of Stephens City Town of Middletown Health Dept. Parks & Recreation Soil & Water Conservation Dist. RECEIPT 142 024264 AMOUNT DUE a AMOUNT PAID BALANCE DUE PAID DT 1-1 CASH CHECK OTHER Ff EDE"RICK COUNTY DEPT. OF PLANNING AND DEVELOPMENT P.O. BOX 601, 9 NORTH LOUDON ST. WINCHESTER. VIRGINIA 22601 RECEIVED FROM L� ,_ _.l• t-_l-____ ` _ L L- 1 !.i, -i �___ _ ADDRESS __S_i I THE SUM Of Z OILARS FOR I Ll LJ 6-11- ; 5P9- oz7--r+ CERTIFIED April 10, 1995 Mr. Moyam Chan P. 0. Box 3731 Winchester, VA 22604 RE: China Town, Permit 4 1782-94 Dear Mr. Chan: COUNTY of FREDERICK Inspections Department John S. Trcnary, Building Official 703/665-5656 Fax:703/678-0682 On our recent final inspection, March 30, 1995, it was noted that building of walls and additional electrical work being done in the basement of your business on Route 50 east. Our records show that no permits are issued at this time for the above mentioned work. Virginia Uniform Statewide Building Code Section 105 1 When Permit is required: Written application shall be made to the building official when a construction permit is required. A permit shall be issued by the building official before any of the following actions subject to the USBC may be commenced: 1. Constructing, enlarging, altering, repairing, or demolishing a building or structure. 2. Changing the use of a building either within the same use group or to a different use group when the new use requires greater degrees of structural strength, fire protection, exit facilities or sanitary provisions. 3. Installing or altering any equipment which is regulated by this code. 4. Removing or disturbing any asbestos containing materials during demolition, alteration, renovation of or additions to buildings or structures. The building official may, at the official's discretion, authorize work to be commenced pending receipt of the written application and issuance of the required permit. If you have any questions, please do not hesitate to contact this office. SincIry, John S. Trenary, A Building Official Cc LI/t7n 6Uya f�` 107 North Kent Street P.O. Box 601 Winchester, VA 22601 Winchester, VA 22604 Q� '�YP 4 0277 - qt COUNTY of FREDERICK CERTIFIED February 13, 1995 Mr. Moyam Chan China Town P.O. Box 3731 Winchester, VA 22604 Dear Mr. Chan: Inspections Department John S. Trcnary, Building Official 703/665-5656 Fax:703/678-06824 Our office was contacted by the Frederick County fire marshal's office concerning the use of the basement as storage at your restaurant located at 1085 Millwood Pike. As I indicated to you and Carla Morrison of the health department, at the time of the temporary final inspection, the basement is not permitted for any use and the storage shall be removed. Under the conditions of your temporary occupancy, the basement area shall not be used for storage. You presently have 24 hours from the receipt of this letter to remove all storage items in the basement. Should you wish to utilize this area for any type of storage in the future, a two-hour designed fire separation detail shall be submitted and a building permit issued and inspections completed. Enclosed you will find an amended copy of your temporary certificate of occupancy. The certificate dated February 3, 1995 is null and void. Please call me to schedule an inspection of the area in question. If you have any concerns, please don't hesitate to contact me. Sincerely John S. Trenary, CPCA y Building Official CC: Doug Toan Carla Morrison a Doug Kiracofe�t Evan Wyatt r+ 107 North Kent Street P.O. Box 601 Winchester, VA 22601 Winchester, VA 22604 :1,1*1 4d , .. VA COUNTY of FREDERICK Department of Planning and Development 703 / 665-5651 Fax 703 / 678-0682 October 20, 1994 Construction Management Attn: Buddy Strawderman 360 McGhee Road Winchester, VA 22603 RE: Minute Wok Restaurant Addition Site Plan Approval Dear Buddy: The Frederick County Planning Department administratively approved Site Plan ##027-94 for Minute Wok on October 18, 1994. The approved site plan calls for an addition to the existing restaurant that will increase the building footprint to 3,935 square feet, the creation of a paved parking lot complete with 38 regular parking spaces, two disabled parking spaces with appropriate ramps and signage, curb and gutter, and landscaping, the installation of concrete sidewalks that are four feet in width, improvements to the existing entrance that comply with VDOT standards, the provision of a concrete loading area, the installation of a concrete dumpster pad that is completely enclosed by a six foot high wooden fence with a latched gate, the provision of a buffer area along the rear of the property to contain a landscaped screen and a six foot high wooden stockade fence, and all appropriate erosion and sedimentation control measures. I have provided you with two copies of the approved site plan. Please provide Mr. Chan with an approved copy of the site plan and a copy of this letter, and maintain a copy of the site plan on -site. Please notify this office to schedule an on -site inspection once all improvements are complete. Please contact me if I may answer any questions regarding this letter. Sincerely, 1 Evan A. Wyatt, Planner II enclosure cc: W. Harrington Smith, Jr., Shawnee District Supervisor T. Roy Jennings, Frederick County Real Estate Keith Burr, Greenway, Inc. 9 North LOUdOUn Strect Winchcstcr, VA 22601 P.O. Box 601 Winchester, VA 22604 Ll SITE PLAN APPLICATION Complete the following application: DATE 9-2-G•-94 1. Development APPLICATION 2. Location of Property: (by street name) MINUTE 1.y�1�. i t 2 4 6y1 l (,-Lu co D P l kr, W(6yAC4CGa-IC e- \jA, 3. Property Owner: tAo ya(,A � 1-1 W)Ak Q'0AM Address: P10, BUY 3-1 *31 WA, , 2 -7 Telephone: 72Z- .I-( I 4. Applicant/Agent: C�2hf�.t11�(9�QU y l �1C, Address: 'Me R(1c-eo, ( _A-ra e W ( 0.1C1+-. (fz k. U A, Telephone: C06Z - 4. (b 5 5. Designer: _c,"RML AS m--,co e-, Address: Telephone: Contact: 1�Ca,cM I Boa-Q, 6. Is this an original or revised Sit Plan? Original Revised -5- 7 . Total area of parcel to be developed: M 0o0 Spa , FT; 8. Property Information:, a) Property ID 64A -4 b) Current Zoning: _P c) Present Use: i2l�STA�2�Fh11- d) Proposed Use: (2M- Tf 0RA i- e) Adjoining Property Zoning: BZ ti RQ f) Adjoining Property Use: 6owg eciAL f�-�St QPY�ITI RI g) Magisterial District: S(+ako(Ar-L I have read the material included in this package and understand what is required by the Frederick County Planning Department. I also understand that all required material will be complete prior to the submission �pof�my site plan. signature: Date: 9-Z6-94 Li L • • February 2, 1995 Chinatown P.O. Box 3731 Winchester, Virginia 22604 This agreement, as requested by Frederick County Planning Department, provides that Construction Management, Inc. Shall seed areas shown on the site plan as soon as weather permits. All other site requirements have been completed. Both parties are authorized and dated as follow: C M I `) Fla B y A/ — Douglas R. Toan Date L �� Chinatown 1 Mr. Chan Date /1 ,,ley", c") > -V,Q 'o-t..rAl S� K7 I /V C- * (,3 ) u /,,? , /9 /.-V er_ z, Iq 02— G/<-6 Lo --ve s/ eo, ^j-: COUNTY OF FREDERICK, VIRWIA DEPARTMENT OF INSPECTIONS • Caller 'It 1poy Time Called Phone No. to65 — CAL 13 Time Requested Received By -VF'3 Date Called Date Requested Date of Inspection PERMIT HOLDER NAME CQ('L�y; n.:�7 P4"' Nr* FIT. NO. Lot No. SEC. No. SUBDIVISION ME r1 1 u P.K STREET NA I •„ -- DIRECTIONS _ BUILDING NO. 1782_ '4 PLUMBING NO. ELECTRICAL NO. MECHANICAL NO. SIGN NO. DISTRICT PERMIT FOR: % N n� u"T �.�K ADD -I Type of InVection Residential Commercial - / y Footers _ Setbacks: FR BK L R _- - Slab Draintile Gas Fire -up Final Electrical Water Service Framing Final Mechanical Sewer Rough Electric Final Site Plan Rough Plumbing Rough Mechanical Final Building Fire Marshall Groundworks Gas Piping/Test Final Plumbing Special/Complaint Other: — -- -- Time In: �� O�n Temperature JS r Cut in No. Time Out: 10 , 30 Weather OvL Q-11"� Results: Approved o.Tom P l - • 0 • Rejected I Comments: ��W PLAN"►- A DD i T'1 ON A-t— S fJ lNST,4_-L_ WfIZt<ING SI6tvS £ NZJ gUS ?�S 516 Signature Date G� �J p!° :.3P:Jr 6Z-1-9 I October 3, 1994 Keith Burr Greenway, Inc. 970 Baker Lane Winchester, VA 22603 RE: Preliminary Site Plan Review of Minute Wok Addition Dear Keith: COUNTY of FREDERICK Department of Planning and Development 703 / 665-5651 Fax 703 / 678-0682 4 k I have had an opportunity to review the above referenced site plan. Please revise your site plan to incorporate the following comments: 1) Please provide the zip code on the developer's address (22603). 2) Please provide a signature block for the Zoning Administrator. 3) Please include the acreage of this site (0.69 acres). 4) Please provide the location and dimension of the required setbacks for this site. 5) Please provide the FAR calculations for this site. 6) Please provide the height for the proposed building, as well as the height of all signs. 7) Please provide the dimension and use of all signs on this property. 8) Please provide a detail or description for the enclosure of the trash dumpster. 9) Please provide all existing or proposed easements that are located on this site. 10) Please provide disabled ramps and appropriate disabled signage. 11) Please provide signage that specifies the area for employee parking. 12) Please revise the perimeter parking lot landscaping to reflect eleven trees. 13) Please revise the buffer with full screening area to read 50 feet. Also indicate the inactive and active portions of this buffer. 14) There is a six foot high opaque wall, fence, mound, or berm required for the buffer with full screening. Please provide a detail or description of the method desired. The location of this object is to be placed between the restaurant and the trees. 15) Please include the percentage of landscaped area for this site (17.3%). 16) Please stripe the loading space located behind the restaurant. 9 North Loudoun Street Winchester, VA 22601 P.O. Box 601 Winchester, VA 22604 Page -2- Burr Letter October 3, 1994 Our department has placed this site plan on the Planning Commission's bimonthly report. I will recommend approval of this site plan once administrative approval has been granted by the Planning Commission, and once all review agencies have approved their portion of this plan. This includes the comments in this letter and all comments from VDOT and the County Engineer. Our department will need five copies of the final site plan that reflects this information. Please contact me if I may answer any questions regarding this letter. Sincerely, Evan A. Wyatt Planner II EAW enclosure a Your sire P!ams.,cld i_^.clude t:e go? lcw:_ y N n IOU'% LA)K Asti -nOO sQ VVcvtCLA) V = 1. Na-e of proposed development 2. Na.-e and address of owner _ _ 30 Na_:-e and address or' developer (ZiP Goof) _ 4. Na_:.e , add= ess , and phone rnrt:^er of designer _ = - Ca—: f icate of suz-veyor, engi_�eer, or arch=tee 6 - Da za plan prepared and date cf revisions 14 7. A l_s =i:.g of al! conditions placed on the site as a result of a conditional use pexrmit or condit'_onal z-ni -,g approval .® A space labeled ^approved by tte Zenizg AcniZistrator" for the approval signatt.:re and date of approval c_ _-.so:=at4cr. •_' N J _ 9. Lccat'_en map (scale 1:2000 ) _ of site = U. Scale of site plan (not to exceed 1:50 ) 12. Ncr`r Arrow — . 13. Zcr 4 . c of s'_ to 14. Use ar_d zcr._nc cf adjeining p=perties r:c` y Y Su_-zeyed bcurda-*-'_es for all lots and pa;ce_s 6 Ac= eage of all lots included in the plan The location and dimensions of all required setbacks and yard areas •18. Location of all buildings, st-uctures, and uses 19. The proposed use of each building, s t- .:c ture , and area Z The location and type of all d-welling units anal i Ground floor area al total floor area of all buildings With FAR calculations for commercial and industrial zoning districts SThe height of all buildings and structures The location and dimension of all signs 7 • Lcs/�sas/?u'____-cs � � �_ _c_••= as (cc-'t ) V ZI r A 24. Lcc`-_cr. c_ outdoor lig t'_ng fi:�•_:res Lcca-icn _i A 26. and ra__ og outdoor storage a_a_s Lcca _ion _ _ 1 fi q 27. and a= ea cf cc=mcr. cce.^. Brace Lcea t+an and descr_ p mien of a? ? recreation f aci? i m_es �. 9 Location of s_dewalks and pedestriar. ways Lccation _ , of cL_dcer t-ash rzcaptacles DETAIL. 02 Roads �QSGRi Pn o� y N — IC- and number of exi.sti_*sg and Planned s ee a On adjoi:L.^g the sites _cca_-on Of ex4st�Zg and planned s _ =_ets or. and ad,cinin g the site _ -44A 32. Dimensicns, boundaries, width, pavement, and c:.r.s t-ucticn of planned roads y _ Lccation and dimensions of all proposed en tra.nces from public right-cf-ways ::: o s Tb BE ' AFf (Z6V -D BY Y DaT' y N TC (3E C.ITV oV 010c"6TOlt— 4 Lccation of all utilities, including sewer and gate= lines with. t :e size of lines, mans , and latera? s Location and width of all easemen is , i ncludi:.c access, util'_ty and drainage easemenQ Lccation and rat-.=e of fire lanes, fire hydrants, a-d all other facilities necessary to meet the Fire Code recui_eme.^.ts -M 6C P&MOVED S%f FiCE Mr425+rr4-L._ Y N 37. Calculations describing the required number of / paXking and loading spaces ,L — 38. Location and dimensions of all parking and lcadins spaces, driveways, parking aisles, curbing, and 39 Location other features to be used and dimension of all handicapped s_ aces 4- to MEET AAA RMUVKCMe:VJT5 8 -r N and f' ^is: ec ccnteuc 1i;.es -aA 41. _cca=icr. of smaeg slcpes, wccdlands, Llccdplai_-:s, w e =_ands , s:L :o? es , ar.d otre= env,-r araen=a =ea yes ! i 42. Lcc`t'_cn of st=aams ar_d d.--a_nace ways Y desc=a-^c _ccaticn and ty-pes c= p la_ zs to be used 44. Lccaticr. c-f =scui_-sd buffers and sc_-eemIng wit-1- c_css sectiers cr crcf_les Y 45. A stcrmwater management _ _r9an off Ca=C:�i a=ices and Iceaticn ya':d desc= =_ =-4 cn c_ aci.lities to be used 46. Sc=1 erosion and sedimentation ccnt:el plan Iccaticr., trees, and examples of. previsicrs to be used -rp a� RpPRovE� b7 c oo a-ry ENG'^�'t�'L 9 Z6 z l e .tea -S UP c� COMMONWEALTH of VIIRCjIINIh �o�� f'r /7 Py DEPARTMENT OF TRANSPORTATION P. 0. BOX 278 DAVID R. GEHR EDINBURG, 22824 WILLIAM H. BUSHMAN CO3MMISSIONER RESIDENT ENGINEER TELE(703)984.5600 FAX (703) 984-5607 November 1, 1994 Mr. Tom Whitacre Ref: Minute Wok Restaurant C/O Buckley-Lages, Inc. Route 17/50 P. O. Box 337 Frederick County Stephenson, VA 22656 Dear Tom: Enclosed is your approved Land Use Permit #855-02768 to cover the reconstruction and maintenance of a commercial entrance and closure of another at the referenced project. Please ensure a copy of the approved permit assembly is kept at the job site whenever working within the Route 17/50 right-of-way. I would also like to remind you of the need to erect and maintain proper traffic control in accordance with our Virginia Work Area Protection Manual. Please give Mr. S. A. Melnikoff a call at 703-722-3460 at least 48 hours in advance of the start of construction to arrange for any necessary inspections. If you have any questions concerning the permit requirements or during construction, please give me a call. Sincerely, William H. Bushman Trans. Resident Engineer By: Robert B. Childress Trans. Permits & Subdivision Specialist Supervisor RBC/rf Enclosure xc: Mr. Steve Melnikoff (wl copy of plan) Mr. Robert W. Watkins TRANSPORTATION FOR THE 21 ST CENTURY OZ-7 -9`I" •V ,•ti �4/IlL�Oi COMMONWEALTH of VIRGIN DAVID R. GEHR COMIMISSIONER Mr. Keith H. Burr C/O Greenway, Inc. 970 Baker Lane Winchester, VA 22603 Dear Keith: DEPARTMENT OF TRANSPORTATION P. 0. BOX 278 EDINBURG,22824 October 17, 1994 IIA H�. BI SHMAN, P.E. ENT ENGINEER I� TELE1703I984-5600 FAX (703) 984-5607 Ref: Minute Wok Route 17/50 Frederick County We have received your revised site plan dated October 12, 1994 for the referenced project. It appecn-s our earlier comments have been satisfactory addressed. Please advise the owner of our approval. A land use permit may now be applied for to cover improvements on the Route 17/50 right-of-way. Said permit is issued by this office and will require a minimal processing fee and surety bond coverage. A permit of this nature normally takes approximately thirty (30) days to process and issue once satisfactory application has been made. If you have any questions concerning the above, please let me know. RBC/rf Enclosure xc: Mr. S Mr. R A. Melnikoff W. Watkins Sincerely, William H. Bushman Trans. Resident Engineer (a /d . g&e-- By: Robert B. Childress Trans. Permits & Subdivision Specialist Supervisor TRANSPORTATION FOR THE 21 ST CENTURY REQUEST FOR SITE PLAN COMMENTS Virginia Department of Transportation Attn: Resident Engineer .P.O. Box 278 Edinburg, Virginia 22824-0278 (703) 984-4133 The local office of the Transportation Department is located at 1550 Commerce St. in Winchester if you prefer to hand deliver this form. Applicant's name, address and phone number: G Ra-7awN . 1 N01910 B eexa Lm E Wi Ncgz zz Name of development and/or description of the request: Location: Vet. Dept. of Transportation Comments: See attached letter to Gre October-14, 1994. Inc. from W. H. Bushman dated VDOT Signature and Date: . 4. C kaw", (NOTICE TO RESIDENT ENGINEER*PLEASE RETUM S FORM TO APPLIC NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach three copies of your plans and/or application form. • �.; •y I fN,�a • �; SPA oa.7-9� COMMONWEALTH of VIRGINIA u V� M.AWM:& � DEPARTMENT OF TRANSPORTATION P. O. BOX 278 DAVID R. GEHR EDINBURG, 22824 WILLIAM H. BUSHMAN, P.E. COtiiyuS5i0A7ER .� A TELE (703)98aI5600 October 6, 1994 FAX (703) 984.5607 Mr. Keith H. Burr Ref: Minute Wok Restaurant C/O Greenway, Inc. Route 17/50 970 Baker Lane Frederick County Winchester, VA 22603 Dear Keith: As requested, we have reviewed the above referenced project's site plan dated August 11, 1994. Our comments may be found on the enclosed plans marked in red and as follows: 1. The reconstructed portions of the commercial entrance on VDOT right-of-way shall consist of a pavement design of 8" of 21-B Aggregate, 3" Type Biel-2 and 1.5" Type SM-2A Asphalt Concrete. The entire entrance surface will need to be overlaid with a minimum 1.5" Type S1v1-2A Asphalt Concrete. 2. The culvert between the proposed DI-3A Drop Inlet and the existing drainage structure on the Route 50 right-of-way is to be reinforced concrete pipe. 3. The existing entrance signs on the VDOT right-of-way will need to be removed. 4. Other miscellaneous items as noted will need to be incorporated into the plan. Please revise and resubmit six (6) copies for final approval. Should any changes be deemed necessary, please design them to meet or exceed the above recommendations. If you have any questions, please let me know. Sincerely, William H. Bushman Trans. Resident Engineer �z ,6. aL�_, By: Robert B. Childress Trans. Permits & Subdivision Specialist Supervisor RBC/rf Enclosure xc: Mr. S. A. Melnikoff, Mr. R. \,V. Watkins TRANSPORTATION FOR THE 21 ST CENTURY REQUEST FOR SITE PLAN COMMENTS_ Frederick County Inspections Department Attn: Building Official P.O. Box 601 Winchester, Virginia 22601 (703) 665-5650 The Frederick County Inspections Department is located at 9 North Loudoun St., 2nd Floor of the Hammon Building in Winchester, if you prefer to hand deliver this review. Applicant's name, address and phone number: to62-,4t$rb Name of development and/or description of the request: M l N LJ T7 IN or Location: J • O • Inspection Department Comments: Building shall comply with Virginia Uniform Statewide Building Code and Section 303 Use Group A Ass ly of the BOCA National Building Code 1993. Other codes that apply are title 28 Code of Federal Regulation, Part 36 Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities. Check fire rating of exterior wall located less that 5" of property line. (Table 705.12) All required Bldg egress shall be ADA accessiba. /A/E s2IL�eq2irea on Code Administrator Signature & Date: �S (NOTICE TO INSPECTIONS DEPT. *PLEASE RN THIS FORM TO A LICANT.) NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach a copy of your plans and/or application form. -14- 0 COUNTY OF FREDERICK, VIRGINIA FIRE MARSHAL'S OFFICE LAND DEVELOPMENT COMMENTS Control No. 0824941631 Date Received 082494 Date Reviewed 091294 Applicant Name Greenway Inc. Address 970 Baker Lane Winchester, VA 22603 Project Name Minutes Wok Phone No. 703-662-4185 Type of Application Site Plan Current Zoning B-2 1st Due Fire Co. 18 1st Due Rescue Co. 18 Election District Shawnee RECOMMENDATIONS Automatic Sprinkler System X Residential Sprinkler System Automatic Fire Alarm System X Other Emergency Vehicle Access; Adequate X Inadequate Fire Lanes Required; Yes X Not Identified ME Comments Posted fire lane required between building and west property line to ensure access to rear of structure. Roadway/Aisleway Widths; Adequate X Inadequate Not Identified Special Hazards Noted; Yes No X Comments - Continued - 0 0 Hydrant Locations; See Notes Adequate X Inadequate Not Identified Siamese Connection Location; Approved Not Approved Not Identified X Additional Comments: 1) Structure is adequately protected by existing hydrant at southwest corner of property. 2) Burning of construction debris on site is prohibited. 3) Access to structure must be maintained at all times during construction. 4) Plan is approved for construction by Fire & Rescue Dept. R i w 5 hr Douglas A. Kiracofe Fire Marshal • REQUEST FOR SITE PLAN COMMENTS !f sip Frederick County Engineering Department Attn: Director of Engineering t•.r P.O. BOX 601 Winchester, Virginia 22601 `7 (703) 665-5643 '' ;'�• °� r , The Frederick County Engineering Department is located'%-,,g o tki Loudoun St., 2nd Floor of the Hammon Building in Winchester;<I,you prefer to hand deliver this review. Applicant's name, address and phone number: Name of development and/or description of the request: MIMOTO 00I<, Location: M06 !PIDYMIR# . . M M Engineers Comments: Engineers Signature & Date: �-- U-QA TO ENGINEERING DEPT. *P E SW ETUR HIS F APPL NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach two copies of your plans and/or application form. —13— 6 • REQUEST FOR SITE PLAN COMMENTS CITY OF WINCHESTER ATTN: Planning Director 15 North Cameron St. Winchester, Virginia 22601 (703) 667-1815 The City of Winchester Planning Dept. is located in Rouss City Hall at 15 North Cameron St. in Winchester, if you prefer to hand deliver this form. Applicant's name, address and phone number: yt � Name of development and/or description of the request: Location: r ' �.i ■ ~ � �--' • ,- -- � � • i � Imo• � •tom --- City of Winchester Comments: * cow%a k,( GAWOM4 Sesv6,60 Director Signature and Date: (NOTICE TO DIRECTOR * PLEAS L"4&jm'Z 4031 THIS FORM TO THE APPLICANT. NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Please also attach a copy of your plans and/or application form. -16-