HomeMy WebLinkAboutCLE200900026 Legacy Document 2012-08-27COMMUNITY OEVELOPMENTI Fax 4349724126 Feb 20 2009 02:41pm P003/006
Application for Zoning Clearance
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Ji Zoning Clearance = $35
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OMCE US9 OINLY
Check # v o pate: !� v
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V�Y�+ SHEETS
PLEAOSE 1M ALL 3
Receipt # 'I / I staff: Cd �
PARCEL EWORMA.TION �U✓ nom`
Tax Map and Parcel: O 14 50 D - OO - OO - O ;t L 00 Existing ZouhR L•J� 1�i
Parcel Owner: MeA call FOr,L1I►' 1t .5 Ot'.f`-} yrrc -G. L kX vs�7`, hlYn�t POfY rirS�la
Parcel Address: SC55 �i f,4 !'� i t� oGt� City (i� r (o 5III state VA ,Zip RA901
(include suite or floor)
PREYLARY CONTACT
Who should we call/write concerning this project?
Address: P.O. 8 ey 'zq' % DO City RO a n y ke, state U A zip Lo i °
tL mce l?hone: (SHO) ??4-747% Cell # rax # E -mail
APPLICANT hNFORMATION
Check any that apply: Change of ownership Change of use change of name New business
Ousiness Nameqype: 1✓ w- r 104C.5 V i I I 2 't ae�'4 11 v rt, q,
Previous Business on this site / ?xiL Pi l7',11 C•. A Ib6f»ar 1G L 4 L 6 d8 Cor„o�
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Xlescribe the proposed business including rise, number of employees, number of shifts, available parking spates, number of
vehicles, and any additional information that you can provide: V'('S 1 to ti h bYM
*This Clearance will only be valid on the parcel for which it is approved. I£ you cbauge, iutensify or move the useto anew Iocation, 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. 1 also certify that the infonnationprovided
is true and accurate to the b t of my knowledge. I blare read the conditions of approval, and I understand them, and that h will abide by them,.
Signature Printed d4cm
,APPROVAL INFORMA Obi
[ ] Approved as proposed [ Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or cim ent test daia nceded for this site, Contact ACSA, 977 -4511, 7.119.
j ] No physical site inspection has been done for this clearance. Therefore, it is not a detm- ninatiom of compliance with the existing
site plan.
[ ] This site cormlies with the site p1 as of t 's date.
Notes- Ml b` &C -2 �'► /� l q
Building Official Date
Zoning Official, Date
Other Official / > G 'ZA i Date
.
County of .Albemarle Department of Community Development
401 Melrntire Road CharlottesvWe,' VA 2.2902 Voice: (434) 296 -5832 )Fax: (434) 972 -4126
Revised 04 /28/08 Page 2 of 3
R
COMMUNITY DEVELOPMENTI Fax 4349724126 Fab 20 2009 02 :41pm P004/006
Intake to complete the following:
is/
IS use I,I, HI or PDiP zoning? If S4, give applicant a Ccrtifiad
Engineer's Report (CER) packet.
Q�r
, there be :food preparation?
If so, give appticant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DA,'l'lE
Circle the one that applies
Is parcel on private well or p liLc w 4
If private well, provide Ilealt D ent form.
Zoning review can not begin urrtl we receive approval from Health
Dept. FAX OA,')<'T .
Circle the one that appli
Is Marcel on septic or pu lies er?
X / ITT
Will you be putting up a new sign of any ldnd? If so, obtain proper
Sign permit.
Permit # . .
X/N
Will there be any new onstrucction or renovations?
If so, obtain the proper Permit.
Perrin #
zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3 3-7-3
V/ N
exz Vved as: nl &t v � LK4 L0 � c
Under Section: 5p t q g � " 4 L � ` 2-11
Supplementary regulations section:
t (.,q
Parking formula:
Required spaces: (,(/1/L-
lu�
X/N
Items to be verified in the field:
lospector :,
Date:
1 n!!s
Violations:
X/A
ist:
Proffers:
X /0>
Ifs
If so, List:
Va ^4a ce:
XI
If so, ist :so,
SP's:
/N
Z i
D -�'o ✓'(ties wt1
l B 5 `(
—�-
Clearances:
SDP's
Revised 04/28/08 Page $ of $