HomeMy WebLinkAboutCLE200900053 Legacy Document 2012-08-29Application for Zoning Clearance
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CLE # �00q "
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k Zoning Clearance = $35
OFFICE USE O vLY
Check # flS n Date: ' d U `mil
PLEASE REVIEW ALL 3 SHEETS
Receipt # `7 1-/ 5 7 2 Staff:
PARCEL INFORMATION ^^ 2
�..,, 3Lvc.1< C(W1/ROisting
Tax Map and Parcel: Q (-1, 47 Zoning
Parcel Owner: C' F,1ZA) Q L - t'P= 39—
Parcel Address °_,.355(p S z_ Y Loy LE -VuA _CityCll1�t121 t�T'() VTLLG State l //� Zip
(include suite or floor)
PRIMARY CONTACT
/write �
Who should we call concerning this project?
Address : City State Zip
c� y ell
Office Phone: C t9 t # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of New business
//Change name
i
Business Name /Type: ��A�f u�d l�� zl rd SGl �PS WO .4o, k (�I�IQA/1l'�2 lw4u- k .4-m7 r ./ wto ceaz*,
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles and au additional information that you can provide: z- CS — 66 C6f try _ -- 5 Pr» P1 9&S
of
*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 die best of my, )owledge. I have read the conditions of approval, and I understand t and that I will abide by them.
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Printed maxJ74d
Signature.C'' F/
AL INFORMATION
WApproved
d as proposed [ with conditions [ ] Denied
VBackflow
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 sitp plan as of this date.
No es: kr • kMbuz Cj-G J,-'�5 . 64-A-d, W Livf CAS)) —S l
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Building Official Date y
Zoning Official Date C) ('
�9
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
Intake to complete the following:
Y /
�
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will t 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 p lic Ovate .
If private well, provide HealthlDep ment 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 is se r?
Y
Wi '1 you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will Ore 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:
N
ermitted as: ley/ 4i9/ c(
Under Section: ,0 iK�;
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/'j
Ifs6/,List:
Variance:
Y/N
If so, List:
SP's:
/If) /N
Ldso, List:
a r
Clearances: -7
SDP's
Revised 04/28/08 Page 3 of 3