HomeMy WebLinkAboutCLE200900017 Legacy Document 2012-08-21Application for Zoning Clearance
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CLE # �(70 q, /1
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Zoning Clearance = $35
OFFICE USE ONLY „ /g
Check # 6 S A Date: f f
PLEASE REVIEW ALL 3 SHEETS
Receipt # g q,5 Staff,
PARCEL INFORMATION
Tax Map and Parcel: 415 — 0 U Q CJ — O/q ,4 Existing ZoningCi
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Parcel Owner:
Address:—
Parcel Address: f r ��LL C�NT�G Gl/i✓� State VA Zip
suite or floor)
PRIMARY CONTACT ����
Who should we call /write1 concerning project?
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10
Address : % ) 6 / l c /" City State Zip
Office Phone: �%�l �f�Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: / Change of ownership Change of use Change of name New business
Business Name/Type: a" 1005 / GI a
Previous Business on this site `x
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide: hall SGlOh',
*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,havee read the conditions of approval, and I understand them, and that I will abide by them.
Signature yrU✓i `acv Printed
AP ROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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.
SGt,t it Se,
Notes:
Building Official Date
Zoning Official Date l
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the following:
Y /
Is us m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will t e be food preparation?
If so, ive applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or pubt�wmrentfbrm. er?
If private well, provide Health I
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p bt�c wer?
Y/N
Will you be putt'.n�up a new sign of any kind? If so, obtain proper
Sign permit.
Peri 1,1,
Y/N
Will there be any ne construction or renovations?
If so, obtain the prop r Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1060
01 N No., I �r.(6 n
Permitted as:
Under Section: �- ✓ / � .. I
Supplementary regulation $ ction:
Parking formula: 51 ^
Required spaces: Q o A, Cl `I k, p IG
Y/N
Items to be verified in the field:
Violations:
Y /
If so, ist:
Proffers:
If t:
Y 4is
Varia ce:
Y/
If so, st:
SP's
Y/N
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3