HomeMy WebLinkAboutCLE200900022 Legacy Document 2012-08-27Application for Zoning Clearance
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CLE # d O �%aa
`�RC;IN�N
�oning Clearance = $35
OFFICE U ON Y
Check # Date: `
PLEASE REVIEW ALL 3 SHEETS
Receipt # 0 Aa Staff:
PARCEL INFORMAL'
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Tax Map and Parcel: ` - Existing Zoning
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Parcel Owner: t�xrPo
Parcel Address: gcl5a f S h P l- Cit O— _ State /f
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? L/1/ y/ S- / (;t6
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Address : (, / 2t�1 C Y��� SCE. (%�/ City �Cf State (%// Zip 2Z�
Office Phone: &PL) (- Cell # Y31�� G 1f f SL Fax # E -mail A "yL ;:S em 6A!� /%I c. .
APPLICANT INFORMA ION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: cy
Previous Business on this site __C c) u hsr�si
Describe 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:
L - 6vi on
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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
APPROVAL INFORMATION
[ ] Approved as proposed Approved with conditions [ ] Denied
[ ] Backf[ow 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.
[ ] Thi ite c mplies with the site plkn as of this d te.
Notes (94, GL G{ a" 5
u
Building Official - Date q
Zoning Official Date
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
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Intake to complete the following:
Y
Is uLI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y acyWil ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not in �n til we receive approval from Health
Dept. FAX DATE 411 %
Circle the on Dwell
Is parcel on privr public water?
Ifprivate we , alth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one 1 plies
Is parcel on eptic o public sewer?
Y
Wil be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /Qae,
Wil r e any n ew construction or renovations?
If s, tain the proper Permit.
Permit #
Zonin2 to complete the following:
Reviewer to complet e the following:
Square footage of Use: 4 C)QO
Prmitted as:.gp MVJ
UnderS Section- J VlY ' �'• �'
Supplementary` e gulat' section:
Parking formula:' 124,0
Required spaces:
Y/N
Items to be verified in the field:
Viola ns:
Y/
If s ist:
Y/
Pror'ist:
If so
Va i i e:
Y/N
If o rst:
SP's:
Y/N
If so, Li
:-Z'2 G
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3