HomeMy WebLinkAboutCLE200900044 Legacy Document 2012-08-27Application for Zoning Clearance
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06oning Clearance = $35
OFFICE USE O Y °L6
Check # Date: 6
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel OwnerA4kLr&
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Parcel Address: ,� (✓ L� / ! `/�1 City -• State , / y Zip 2-2
(include suite or floor)
PRIMARY CONTACT 1
Who should we call /write concerning this project? 26Z. r
Address: () Cc- M � r �r . City NA AO FTr.c m)) State ff tp Zip
Office Phone: ( S - C Cell # L3y -S-$J-6 1Z
Fax # / E -mail -Daor a t1Yi?✓4 _.l-ry s4 -A,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use ✓"Change of name top" New business
Business Name /Type: J n it P C ti ��/�I a r �� � -r K u, \ r
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Previous Business on this site Z'1 -01, N f A AcI tAJ e L�!'— ZA 1 Z -C
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: (Y A ; C,} � c �x � � s �� � e �,�-, � �„�s11;
90 128jzlz G� �i2 Gk
*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 to best of m owled e. I e read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL 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
C (! e r-,
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Intake to complete the following:
Is/
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/n
Wil 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 ublic water
If private well, provide Hea pa mint form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap 'es
Is parcel on septic or ublic sewer?
i/ N
ll you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /lNh
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: //-000 (,23X,V
0
YIN
Q y
Permitted as: YL�(- a- � �Q �l C-
Under Section: I - �7
Supplementary regulations�ection:
K, q
Parking fount}/ X,6- It
Required spaces: 15
YIN
Items to be verified in the field:
Inspector•
Notes:
Date:
Viol tl ns:
Y/W
If so, List:
Proffers:
Y I K
If so/,-List:
Vari e:
YI/
If so, ist:
SP's:
Y /N
If so, List:
Clearances:
SDP's
t, CMA ri mr, 6 v /i �
ZS
Revised 04/28/08 Page 3 of 3