HomeMy WebLinkAboutCLE200900061 Legacy Document 2012-08-29�-- AotnL T(ctcl-V 6VCL----
Application for Zoning Clearance`
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CLE # 2DOR' CQ
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`�RGIN�P
g] Zoning Clearance = $35
OFFICE USE ONLY
Check # 6 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # y Staff: d & Gll'I'�Q�/
PARCEL INFORMATION
Tax Map and Parcel: No I W0030660 (oA I Existing Zoning
Parcel Owner: J1 u P-T t NV t-ST AA&A) T C .
Parcel Address:. 335 Ct N eev b r e)'�- 111 . City CVA/i _ k tate Zip
eLtiT _ M_5 (include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 51�-%A- vYlet.-L 'ON - IIZGIN /H LAN D (o
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Address : 1 °t 5 %V& P-BENb D R . City �(� lui��e%w�(lG State �% Zip ZZ�tO
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Office Phone: � t -!• 61 I Cell #010& •� 588 Fax # AC16 ~3516—E-mail V LGyV1eJ +CV1 & CL0 I •
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name VNew business
Business Name/Type: (,QNi1L0C- V- ?AL1Z�/MPL �bS 1
0lATSTok) 4GS j7� ILn mee-c'-2.S
Previous Business on this site oug-
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
1
vehicles, and any additional info(mation that you can provide: COVISW+1 nlL-7 SLV1CI iV161 �/' S : L O Tt7 (-P eL rll [
CovhQQU4!!1 VOWN Si I a emnli tGuP Q v -t(na 1.P !S
No &I I a !IT- .5 Et t FT S
*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.
Signatu - Printed %� -j2.�( b - G1 LLI LA AJ I3
AP OVAL INFORMA ON
[M 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. s
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date `-d )� l o i
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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" I Intake to complete the following:
335 C:f vice-lt -,A �
UJ 91T LO C-Lb A L P -Y,,Li P L!:Z„
Y/A
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will 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 o<
pu;b—lic:w:a:t:e;9)
If private well, provide Healt artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o nb is sewer?
Y /O
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 #
Zoning to complete the following:
DI-Z, S� Zos'
T& A.) t- A S SOL
Reviewer to complete the following:
Square footage of Use: W Y
Permitted as: Atel
Under Section: oS N 1
Supplementary regulation $ section:
w`
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3