HomeMy WebLinkAboutCLE200900028 Legacy Document 2012-08-27Application for Zoning Clearance
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CLE # ��/�� Z�t�
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Zoning Clearance = $35
OFFICE USE ONLY
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Check # .5Is 3 Date:
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PLEA REVIEW ALL 3 SHEETS
Receipt # 7 Staff: ,
PARCEL INFORMATION , `C
Zoning �7
Tax Map and Parcel: Existing
Parcel Owner: �OG��iyJY °le
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Parcel a� ✓� l �� State Zip
Parcel Address:
(include suite or floor)
PRIMARY CONTACT '�
Who should we call /write concerning this project ? /✓�IVC
Address: r!c,y� �G �O"� City �ve /!c- State Zip 7—L'F0
Office Phone: (La 2�S—Y�1,3 'Cell # YSY'ZYZ -7N x # �� E -mail clo ve d 02 �hCVA"I`loa.11�
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
11Change
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4-e- ` Business Name /Type: �t `GV�G.y�c�y e- e GY C6 /r5✓,s e—
Previous Business on this site J G ✓���
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
Vl��se /esp��a �x.r
vehicles, and ny additional information that you can provide: ttc e ao S�Gv�pl�ees
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*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 f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
kJ Approved as proposed j ] 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 1i
Zoning Official Dat7
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
Z
Intake to complete the following:
Y / 1-
Is u I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y J/ N
Il there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be in ntil we receive approval from Health
Dept. FAX DATE o
Circle the one that applies
Is parcel on private well or ublic water?
If private well, provide Healtl epa inentfcrm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appki
Is parcel on septic or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
footage of Use: 46-3
Y/N t
7.rmitted as: C(i� �r G o
Under Section:
Supplementary regulatio s section:
Parking formu
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Date:
�.� n W I LTi3iM YMM" 71l1
ff
Violations:
Y/N
If so, List:
46 a
Proffe :
Y/
If so, st:
Varia e:
Y
If Oii-s t :
�s:
,Y / N
so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3