HomeMy WebLinkAboutCLE200900067 Legacy Document 2012-08-30,p
Application for Zoning Clearance
CLE #
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[oning Clearance = $35
OFFICE USE ON ��""
Check # z i y Date: i�t(G
PLEASE REVIEW ALL 3 SHEETS
Receipt # 1L Staff-
PARCEL PARCEL INFORMATION 22 3-76
Tax Map Parcel: — Existing Zoning �h`✓17r alyly
and CJ(32,-
Parcel Owner: L_Jn liea 0. l..l�.
ParcelAddress:_3yb�° �c�o \Q�roJ� \, �,j�2.1� City OA)aT\6�Ae, State V1 -1 Zip 9kk
(include suite or floor)
PRIMARY CONTACT
\L
-)-,
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Who should we call /write concerning this project? `�W O. C�
Address: \)FSO Sh2�AS� V�1 phi. City ° `p State '1 A Zip ZZ98U
Office Phone: U Cell # 5NO • Lk-l%•31y1 Fax # $(o(e' WS- lggkE -mail ,11ic)Q,S C��2�fl5. C.oc�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name V New business
Business Name /Type: N�2. \OS W�� \e.ss CZXhtAUS,j�C�pnS
Previous Business on this site IPj
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: 0_-&�e_ —
e� uuomr�n'� •>�1uc2s . C-�oacox . 5em�\au��,S
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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.
A0 Signature Printed _)ayo.
A"OVAL INFORMATIO
[VI 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 Ian as of this ate
Notes: (2, b ?/k L
Building Official Date -Ii
Zoning Official Date 12 O
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 / 1[�
Is use m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/N
Will there 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 public water?
If private well, provide 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 septic or public sewer?
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 2-Apr5 D
`'N
Permitted as:
Under Section:
Supplementary regulat om section:
Parking Lign I / /,z
Required spaces: '2�
Y /N��
Items to be verified in the field:
Inspector:
Notes:
Date:
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