HomeMy WebLinkAboutCLE200900029 Legacy Document 2012-08-27Application for ZoW n Clearance
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CLE # �V f - T'/
Zoning Clearance = $35
OFFICE USE ONLY
Check # ii cif Date:
# 9U7 Staff:
PLEASE REVIEW ALL 3 SHEETS
Receipt
PARCEL INFORMATO
Tax Map and Parcel: Existing Zoning
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Parcel Owner: s- 2 c c C_..
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Parcel Address: jO 3 City c �c f )Jf e State / Zip
(include suite or floor)
PRIMARY CONTACT
lod �CC) k
Who should we call /write concerning this project? q vh
Address: City �i �' '1 l State , Zip Z ZS k
Office Phone: ( `�v Cell #g����`( Fax # E -mail
APPLICANT INFORIYATION
Check any that apply: Change of owne1rship Change of use � Change of name 2 New business
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Business Name /Type: ` G1iw L.1 /v- b
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Previous Business on this site l V\.A f L I VL410
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: ��a�lG�/7 d� j✓li%! /�1 � r�°�G �-�!
Is"z a .
*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 infonnation provided
is true and accurate ie best of knowledge. I have read the conditions of approval, and I understand them,, and that I will abide by them.
Signature /�_ L' _ Printed c'� [� AJ C C d L� c,-,__
APPROVAL INFORMATION
[ ] 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 co pli s with the site plan as of this date.
Notes:l/VG� C7 ✓t�l i�• CeLi't G V� T
AV? AA
Building Official Date -1i
Zoning Official Date�V�
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 , HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi " ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or( is wat r?
If private well, provide H epar ent form.
Zoning review can not / gin nit' we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p li wer?
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 ne construction or renovations?
If so, obtain the prop r Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: 00
(Y'
/N rrrr ermitted as: O-+ ( C 5,h CV x Ce
Under Section: .6� d �� 26 ��
Supplementary regulation e ion:
Parking formula: >> D o ��Ol
Required spaces: alt ��j VVI n^
Y/N 4
Items to be verified in the field:
Inspector : Date:
Notes:
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