HomeMy WebLinkAboutCLE200900078 Legacy Document 2012-08-30i
Application for ��rZonin Clearance
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Zoning Clearance = $35
OFFICE USE ONLY � n
Check # 15,J9 Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # '750 73 Staff: �/ I F✓Y�P..�
PARCEL INFORMATION;q ��,,/q�
Tax Map Parcel: / � � �
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and (/ Existing
Parcel Owner: Y &J( 1J od �, b-W 190 L6f O &�
Parcel Address: 7.01 � VJoe 4 r•1 k E +• City [ - V<<l a State ✓A zip! ;06
(include suite or floor)
PRIMARY CONTACT + r,.
Who should wpe'Lcall /write concerning this project? �tQ N t (s a y� p tS19 t1 &IM o4le-e
Address : q k✓C A167 City L -VI l/,c State V A Zip Z. Li a
Office Phone: (y3) 17l • f/ ($ Cell # ZyZ • 37 67 Fax # 17 7. St E -mail
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APPLICANT INFOR41ATION
Check any that apply: Y, Change of ownership Change of use Change of name New business
Business Name /Type: Ed pt. hKct I b.bs. LJQV^mac` Dtftb %t (ire
Previous Business on this site 1`'GIJ
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: AA 1 S{-_ 041 t o 1- L 44v4 +1 5 t" S .
6- S t.m olge el
*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 t the twst my knowledge. I have read the conditions of approval, and Iunderstand and that I will abide by them.
them,
Signature Printed�t 4 " 7-ed 0 PC Is a -1
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
Zoning Official �I Date -.0 ��j ¢
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:
Is / l I
Is use I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will e 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 blic Ovate .
If private well, provide Health t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
wil N
there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete �thf /e following:
Square footage of Use:
0/N
Permitted as:
Under Section: 77-- Z IZ
Supplementary regulations section:
Parking formula:
Required spaces:
Y / N �—U 6� SCeS r� k►�
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, ist:
roffers:
/N
so, List:
ri ce:
'gist:
SP's:
Y/N
If so, List:
49��9
Clearances:
65
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SDP's
S l _ 75 �
6e
—
D?
— 71 � -i�, 2i7
Revised 04/28/08 Page 3 of 3