HomeMy WebLinkAboutCLE200900056 Legacy Document 2012-08-29A pp lication for Zonin g Clearance
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Zoning Clearance = $35
OFFICE USE ONLY �/ D
Check # r 6 Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # �L Staff: _
PARCEL INFORMATION
3 / R G
Tax Map and Parcel: Existing Zoning
Parcel Owner:O tt✓[ �� (�C(L[ fCl�d �i Cc 't- ��'t�- , (. tU�
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Parcel Address: P- e,?-15- �'�7C�il� ���.G� City State Zip�Z�� �
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: z Z t� ��` lce'i� -��a- City We '-. -State Zip
Office Phone: ( ) o`M-`L b 1. Cell # Fax # 2—Jk5 d 6 ? E -mail
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APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
!Change
Business Name /Type:
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:
*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 Printed
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, 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 �O'O
Zoning Official Date
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 / ly i
Square footage of Use:
Is u e in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
O/ N
Y / N
ermitted as:
Will there 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 a lies
Parking formula:
Is parcel o private well or public water?
If private we ro e ealth Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y /
_7
% „I
Circle the on$4At applies
Item to be verified in the field:
Is parcel on eptic r public sewer?
Clearances: i
SDP's
Y/0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector Date
Y /JO
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmrilpte the fnllnwinu:
Violations:
/-/I-q
If so,"List:
Proffers:
If o,T51st:
Variance:
Y/(
If so", -fist:
SP's:
/N
f so, List:
.J 7
'74 _ 1 .i
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V '
Clearances: i
SDP's
Revised 04/28/08 Page 3 of 3