HomeMy WebLinkAboutCLE200900045 Legacy Document 2012-08-27Application for Zoni*n2 Clearance
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PARCEL INFORMATION p
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Tax Map and Parcel: Existing Zoning �� i Cy CAA 'T'c ak
Parcel Owner: C a • d A t ( •e.,vr. cv,. (e. u d r- 4P
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Parcel Address: (,-1 5% A-Voyx Si- • F Zc i-� City C k C.t.W (o �-ts yt to VA Zip 2:Z-9ci
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project? 1 Y'0- c. -,9- 1,4
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Address: IBS Z 13 Ic�e.�-I-%, C�y v. Ln, City C (�(2AbA- VI t(t.,State VA Zip z:9,C5
Office Phone: ( 3 (" 30 -13Cell # 9 Z' (� %Fax # '2`� �v ° 2 l3 _mail (^ + V@ e?rr► �c c 1Mc2 l
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APPLICANT INFORMATION
ec an tb . ti:Pr . �Chantge %own hxp Iffil � � 1a g a ss
Business Name /Type: to L c- s J, v
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Previous Business on this site
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: IQ 5� lS 01& A oL QaA e-, e, 5a-�
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*This Clearaficdwill only be valid on the parcel for whic it is approved. If you change, intensify or move the u to a new location, a new Zoning
Clearance will be required. VO i It � (_S 0 {v-z- UUCS C d ,
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 information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and thaattfI will by them.
abide
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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:
Is/
Is usU LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
�
Wil ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive ap royal from Health
Dept. FAX DATE
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Circle the one that app ins
Is parcel on well or public water?
If private well, pro ide Health Department form.
Zoning review c not begin until we receive approval from Health
Dept. FAX D TE
Circle the one t t applies
Is parcel on septi or public sewer?
Y/N
Will you be putti g up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any n construction or renovations?
If so, obtain the prope Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/ N —f-� Q V6 e6(,6
.-witted as:
Under Section: jP ( I'L° C2 v
�z
Supplementary rnguflattiions section:
Parking formula:
Required spaces:
Y/N /
Items to be verified in the field:
Inspector:
Date:
i •�� NTMTZAFIMT
Violations:
Y/
If so, st:
Proff s:
Y/1
Ifs , List:
Variance:
Y /
If scost:
SP's:
Y /, ITT
If so, ist:
Clearances:
SDP's
\ Revised 04/28/08 Page 3 of 3