HomeMy WebLinkAboutCLE201200166 Legacy Document 2012-08-28Application f ®r Zoning Clearance
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CLE # a(M - Ittl(T/
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OFFICE US, + ONLY
# Date: $'
PLEASE REVIEW ALL 3 SHEETS
Check
Receipt # Staff:
PARCEL INFORMATION .7 /
'l �f Existing Zoning
Tax Map and Parcel• -'
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Parcel Owner:
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Parcel Address: r �' ,'�fsC% City 4bj-t,1A,State l Zip
(in Nude suite o � flo r�
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PRIMARY CONTACT
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Who should we call /write concerning this project? V (A Q�(
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Office Phone: _ Nq° 3Zt Cell # C32-1)_9 Fax # E -mail C4E 1-1 Wfi?Us 'Oit a o F0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: G�i t2-u� ZT `7� l L �- F� 1 A 5 Se-) G
Previous Business on this site 1`' k F -VLW,+ —\ cow Lk L y 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: QQ -F e-L-tb,.StC 13D6L5
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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 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 that I will abide by them.
Signature je! � \ �ti-+ -�-_ Printed G_rAM '
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 !Z✓ Date "4
Other Official Date
County of Albemarle Impartment of t-ommunuy Leveiopu►euL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Is UI LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 b1: at r?
If private well, provide Heal i�- k
in form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a�pTie
Is parcel on septic or ifulblic se
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to cmmnlete the follnwino:
Reviewer to complete the following:
Square footage of Use: -7i7 oo
(0/N Q-� �
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Permitted as: ' ,LI d 1
Under Section: )IN 2
Supplementary regulations section:
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Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If so,gist:
Proffers:
/N
if so, List: / G
Variance:
Y/
If so, ist:
SP's.
Y /
If S6',' List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3