HomeMy WebLinkAboutCLE200900033 Legacy Document 2012-08-27Application for ��Z)oning Clearance
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Zoning Clearance = S35
PLEASVREVIEW ALL 3 SIIEETS
OFFICE us N v 9
Check# '�/ Date:
Receipt# 6 Stat'f:_
PARCEL INFORMATION -Pb
Tax Map and Parcel: 78111.0 Existing zoning S V
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Parcelownon b S )11� &n i LLC
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Pm cei Address: 3 7� S aj City ChW109$1//�tate V A Zip
(include SURE or floor)
Who should CONTACT Susanne it o4 u t
Who should Nye crahihvritc concerning this project? f- J(� oo
Address: 3355 -&r� ftw Sv City �tl/O4kSV +)K- state VA Zip U/0
Office Phone: 3 `/'73KX;cll # Fax # Email ��et�l @ ills O/
�3 -&gypp ''99 273'(52 7/ dt �.
APPLICANT INFORMATION
Check env that apply: Change of ownership Change of use _Change of name New business
Business Name/Type: i�urrin @ Rnivp5 pe,� Sire
Previous Business on this site
Describe the proposed business including use, number of employe s, numb • ot'sh7'g; avails le p rlyl gspaces, nm iber of
vehic es, an any addJt'ional information that you can provid : CGL'TS Qi} �1
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*This Clearance will only be valid on the parcel forw•hich it is approved. If you change, intensify or move the use to a new location, a newZoning
Clearance will be rcyuircd.
I hereby certify 1141, own orhave dte owners permission use the space indicated on this application. I also certify that the infomunion provided
is true and seen to Ute best o f my kn w e vc r ad the c tditions of approval, and I understand them, a�nd I wy ill�abide by them.
/that
Signature Printed
APPROVAL INFORMATIO ,
[ ] Approved as proposed Approved with conditions [ J Denied
[ ] Backlloa prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, x 119.
[ ] No physical site inspection has been clone f'or this clearance. Therefore, it is not a dctennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official A -c -t -�� a Date L��� 1
Zoning Official Date
Other Official Date
county of .vnemartc uepartmentof t:ommmiuty Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04 /2S /08 Paget or
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All
Intake to complete the following:
Reviewer to complete the following:
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Square footage of Use: I R O O
Is ui1-4 HI or PDIP •roning? If so, give applicant it Certified
Engineer's Report (CFR) packet.
Will I re be food pt•eparulion?
If so, give applicant a Health Department farm•
Zoning review can not begin until we receive approval from Health
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(Y y N pp..
rmitted as: IL -tA I
Under Section:
Supplementary regulations section:
Dept. FAX DATE
Circle the one that appll
Is parcel on private wel� public tva r?
Parking formula: /
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Required spaces:
rd
If private well, provide H th De ri e.. form.
Zoning review can not begin Until we receive approval from 1-lculth
Dept. FAX DATE
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Circle the one that appl�
parcel on septic or pu +-ll c sews ?
Itc o be verified in the field:
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✓/N
Will YOU be putting up it new sign of any kind? If so, obtain proper
SDP's ,�ll
Sign permit, q — y
Permit # () I 2 5l
Inspector: Date: _
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Notes:
1Yiere be any new construction or renovations?
If so, obtain the proper Permit.
Permit S
�tolations:
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S'I so, List: S{ --7
Proftiys:
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I o` List:
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Ifso, L ist:
SP's:
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if so, List:
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Clearances:� /
1 )c� i^1fi N %
SDP's ,�ll
Revised 04 / 28108 Page 3 of 3