HomeMy WebLinkAboutCLE200900071 Legacy Document 2012-08-30u a�g�5� d_8s
Application for Zonin Clearance;
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CLE # '"
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] Zoning Clearance = $35
OFFICE USE nNi.v
Check # y: 7 Date: % i U q
PLEASE REVIEW ALL 3 SHEETS
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Receipt # '_16' 0_61 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 5 — 23131 Existing Zoning
Parcel Owner: t �t `l �rla w� L� �/ 1 ID�U�LoJcj__�, L L'
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Parcel Address: 19 95' r—,j �1 izy City State \,+ Zip -
(include suite or floor)
PRIMARY CONTACT '
&x- Ly L10
Who should we call /write concerning this project?
Address: P0. 3og 0007-q(D City G 'Q L� State V Zip2 d
Office Phone: � ) 021f _932.I Cell # Fax # 324—nO(67 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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BusinessName/Type: VA Map cg M [ of ue0L ( LVAiXe 640U5aC
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Previous Business on this site�.0�
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you c n provide: ��}�� lck Wr I( ba vjS D l F K0u.5C
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*This Clearahce 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 G,4( -1 F
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
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Zoning Official Date�� G�
Other Official P Date :9 9// 1)
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:
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Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
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If so, give applicant a Certified
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic
If private well, provide Healt� apartment form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o public sewer
Y PN
Wibe putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 13 9,00 9 PO
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �7 ooc�?
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rmitted as: ve, Wu, `
Under Section: �
Supplementary regulations section:
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Parking foi•mula:�
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Vi3,'"ist: ons:
Y
If
Proffers:
Y/�
If so, List:
Varian
Y/ V
If so, List:
S 's:
N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3