HomeMy WebLinkAboutCLE200900081 Legacy Document 2012-08-31Application for Zoning Clearance'
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CLE #
vIRGINtP
oning Clearance = $35
OFFICE USE ONLY
Check # � &7y Date: �G O
PLEAS REVIEW ALL 3 SHEETS
Receipt # 7.7714 Staff: 7' tiJ
PARCEL INFORMATION
Tax Map and Parcel: d ®3 oo oc) �w Existing Zoning
Parcel Owner: I(�Z��C�✓'� ,J Voce �n 5,� (
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Parcel Address: Z"I J -city
(include suite or floor)
PRIMARY CONTACT II ' r�
/write �9- S �. '.-f— (>✓ +�
Who should we call concerning this project? l�
r
Address AU "4 � � Cp,.r, ,_p bc_t , �j City IGcS W i c-A -- State V cA Zip uSN 1
Office Phone: C__J) �9 Cell # Fax # E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: (,��.d -5- ifi jr�J►r� `S
Previous Business on this site ( =jL)o 4C.
Describe the proposed business including use, number of employees, number of shifts, avilable parking spaces, number of
vehicles, and any additional information that you can provide: �-C_( (,, ^A �. rc,u 3,�K 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 o he best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed U�
Signature
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.
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Notes: yZAL CUA- 3y v- -r1'VYQ U_Z ! �� (' y� W! leZo
Building Official Date
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
Intake to complete the following:
Y rN
Is u in LI, HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Wr 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 ublic j er ?If private well, provide Hea epaent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap I•
Is parcel on septic o ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 's
Y ' v` io
Wrl ere be any new construction or renovationn
s?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: VI
/N "
•initted as: �iW D V1 O'L -SGT
Under Section: �f1e-
Supplementary reg lafions section:
Parking formulas l
Required spaces:
iGu-
--
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