HomeMy WebLinkAboutCLE200900036 Legacy Document 2012-08-27Application for Zoning Clearance
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Zoning Clearance = $35
OFFICE USE ON Y
Check # � Date: ;l
PLEAS VIEW ALL 3 SHEETS
Receipt # -. 341 Staff: L�
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner : J V Z L_L_,'.
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Parcel Address: �01,5 ��C LL City 0, 1 0u.A,, i,�( tate VGL zip 12
(include suite or floor)
PRIMARY CONTACT �(�
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Who should we call /write concerning this project?
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Address: &nt 1 ft . City 0,16 6k-51 A State Zip
Office Phone: ( 97� 0:5 &ell # Fax # VAtf L/`%% E -mail L `vim WE,- 7-0, ' j J ("
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 64-3w, .Qa�A� nvx 0—l'�GZ.h.� "
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Business LIII A--
Previous on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: %3&"e fYl rc a
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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 - s permission use the space indicated on this application I also certify that the information provided
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is true and accurate o t e s I have d the conditions of approval, a 1d I underst nd t_h�e�lm, and that I will abide by thP i,, /, Q, P+
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Signature ( Printed h I /
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AP OVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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
Zoning Official Date 3
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
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Intake to complete the following:
Reviewer to complete the following:
Y / N
Is use in LI HI or PDIP zoning? If so, give applicant a Certified
Square footage of Use:
Engineer eport (CER) packet.
Y / N
Permitted as:
Y / fi
Will ere be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
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 Healtli-
Required spaces: -
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
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 permit.
Permit #
Inspector: Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnlete the fnllnwinor:
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