HomeMy WebLinkAboutCLE200900006 Legacy Document 2012-08-22Application for Zoning Clearance
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CLE # 2t,6 — GF. <` .
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OFFICE USE OP'
Wining Clearance = $35
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Check # Date:
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PLEASE REVIEW ALL 3 SHEETS
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Receipt # 173ZiS 5 Staff: �p 7
PARCEL INFORMATION
Tax Map and Parcel: AS e- ' y I - A 1 Existing Zoning
Parcel Owner: b l� %S f �� v Q- �p2 K-2
Parcel Address: / G'--cL('l City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �� �orc Q-[ [� L��W (- ✓���
Address: City C-4 ,1(4- U'01(2 State V Zip 00-4�y�
Office Phone: (3) a� c(a�ePax #E�Lb E-mail Ay.,-c.S�2i zZo 2 lr�v-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of-use Change of name New business
Business Name/Type: 5 ""4 �1 2'ZsL
Previous Business on this site 2 w r 0 r-,
Describe the proposed business including use, number of employees, number of shifts, available parking sp ces, number of
vehicles, and any additional information that you can provide: o
*This Clearance will only be valid on the parcel for which it is ap roved. 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 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / Printed
APPMOVAL INFORMATION
IV', ]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.
Notes:
Building Official - Date j' 13
Zoning Official ' Date �� �(3 0 c�
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
Revised 04/28/08 Page 2 of 3
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Intake to complete the following: I Reviewer to complete the following:
Y / N
Square footage of Use: _
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Y, N
Will there be food preparation?
Permitted as:
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin til we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE ) r
Circle the one that applies -
Is parcel on private well o public water?
Parking formula:
If private well, provide Hea epartment form.
Zoning review can not be in un it we receive approval from .Health
Required spaces:
Dept. FAX DATE �C
Y/N
Circle the one that applies_.._
Items to be verified in the field:
Is parcel on septic o public sewer.
N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector • Date:
/ N
Notes:
Will there be any new construction or renovations?
If so, obtain the prop er Pe t.
Permit # �
Zoning to complete the following:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3