HomeMy WebLinkAboutCLE200900023 Legacy Document 2012-08-27Application for Zoning Clearance
CLE # +r y
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OFFICE USE ON Y
❑ Zoning Clearance = $35
Check # n Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # ` Staff:
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PARCEL INFORMATION yyJJ���
Tax Map and Parcel: " �`�'� Existing Zoning �, ^� ► no
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Parcel Owner:
OV20
Parcel Address: �J�l twi'll Dr. Cit State Zip
(inc ude suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?�
Address : City State Zip
Office Phone: CM #Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employee her of shiflill available parking s aces, number of
vehicles, and any additional information that you can provide: `L/ y ( aa±: j P 24 $q . .
*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 have read the of approval, and I understand them, and that I will abide by them.
conditions
Signature �� �'� ��x (/L G Printed c22 &, lz Z..-
AP ROYAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacl&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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date -.-4-1 `(
Zoning Official Date =5Z�) y
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 in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can n t be in it we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well public wa er
If private well, provide Hea t i epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic ublic sewed
W Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following: j
Square footage of Use: l 4 2)q
/N nnom�''_ �r��
ermitted as: e 1 �/S,'^'u I i�/ P/u4
Under Section: oz. t
Supplementary reg lations section:
a
Parking formula:
Required spaces: fo OA
Y it Nl �tJ UK� Vdv
to be verified in the field:
Inspector•
Notes:
Date:
Viol 'ons:
Y /
If so, List:
Proffers:
Y /cI`'L
If s 'gist:
Variance:
Y 'li
If so, st:
S 's:
/ N
sow
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3