HomeMy WebLinkAboutCLE200900035 Legacy Document 2012-08-27Application for Zonin Clearance
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CLE # D -
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Zoning Clearance = $35
OFFICE USE O LY
Check # / j Date: c7 ' i� '0_9
PLEASE VIEW ALL 3 SHEETS
Receipt # Staff: L% .
PARCEL INFORMATION 04m I r\� - rrta -n CL i
Parcel: W— JID6,57 Existing Zoning
Tax Map and
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Parcel Owner: W(1/I ,
Parcel Address: ! �� City at—1 "'p h o 'I'Mate V / ` Zip�� 1 L
(include suite or floor) - -
PRIMARY CONTACT //ll /
Who should we call /write concerning this project? ,,A
Address: (Old zQ' m City 0/1V lkkS (A State V Zip
Office Phone: (JA 7 7 L)5 Cell # Fax # W-grz z' l =mail gee+ P J
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: & e r
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Previous Business on this site ' 1 / / / k
Describe the proposed business including use, number of employees, numb r of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 'a e
One , .Ff & es e
*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 he required.
I hereby certify Mlow have the okr' m>ission use the space indicated on this application. I lso certify that the information provided
is true and accust of m no I haver ad the conditions of approval, an I tnderstand iem, and that I will abide by them.
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Signatur Printed ' v I a
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AP OVAL INFORMATION
[ kj Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backilow 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 G 3 `z
Official Date
Zoning
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
I- ...-
NO- ,
Intake to complete the following:
N
use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
O Will he 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 public water?
If private well, provide 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 septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmnlete the fnllnwin¢-
Reviewer to complete the following:
Square footage of Use: � ;' 6 q
l N wY Loft J/A&
ermitted as:
Under Section:
Supplementary regulatiois t�tion:
Parking fonnmyla:/ fYnI, ` I / -6 ci C`-
Required spaces:
Y/N
Items to be verified in the field:
ViolV*.,s:
Is
If so, t:
Proff
If Bost:
Var'ai ce:
Y/N
If so ist:
SP s:
Y
If so, 'st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3