HomeMy WebLinkAboutCLE201200110 Legacy Document 2012-07-13It
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Application for Zonlin 1' 4mi
CLE# 2012 - IF0, 811-i't
OFFICE U
NVY) Date:
PLEASE RE' VIEW ALL 3 METS
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Receipt ff staff: fYW- J
PARCEL INFORKIAXIpg
Tax Map and Parcel, Existing Zoning_
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Parcel Owner- _M,6111m 6W
Parcel Address. 1yrM1yU_0&_ ::54 city A"I State Zip
(Include suite or floor)
PRIMARY CONTACT
Who should we enil/write concerning this project? 6nm
Address: IV• city oyak'k state VA Zil)
Offica Phone-, C yw?ax E-mail 1AIV4410d JoA16P
Cell
APPLICANT INFORMATION
Check any that apply: _.L/ change of ownership Change of use _----Change of name New business
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Bus(nessName/Type.- f.) 17 cca�k
P revio us Business on this site
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,
Mils Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a now 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 accurmte to tjq best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed -_—z2L,'y_n&C -2 017,
APPROVAL INFORMATION
Approved as proposed Approved with conditions Denied
rl Backflow prevention device and/or current test data needed for this site, Contact ACSA,977-4511,xII7.
[.]No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date,
Notes.
Building Official z� Date _-I�— I
Zoning Official Date
1215of
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (04) 296 -5832 Fax; (434) 972-4126
Revised 7/1/201 I Page 2 of 3
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Intake to complete the following:
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
W/N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE S/Z , I Z'
Circle the one that applies
Is parcel on private well or lic w. r?
If private well, provide Health Department form,
Zoning review can not begin until we receive approval from Health
Dept, •FAXDATE
Circle the one that ap
Is parcel on septic or p sewer
Reviewer to complete the
Square footage of Use:
SIN
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
*d
vo
Required spaces:
Y/
Items o be verified in the field:
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. Inspector : Date:
Permit #
Y I N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7 t .] R.fU •C 11..
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Violations:
Y I
if 1st:
Proff
•Y
If so, List:
Varia ce:
Y
If so, 1st;
IN
If so, List:
93— 5f
Clearances,
SDP's
Revised 7/112413 Page 3 of 3
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