HomeMy WebLinkAboutCLE200900084 Legacy Document 2012-08-31Application for Zoni g Clearance is CLE
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PARCEL INFORMATION � �� � �
Tax Ma p and Parcel: I Existin g Zoning
Parcel Owner:
o Nm
r /n1�I ,,�"""" IIII 1n�
Parcel Address: 31 a�"k a,M City eAdr4n �6�aV1� k State V �J Zip
(include suite or floor)
PRIMARY CONTACT &AW Who should we call /write concerning this project?
Address : r Sw V75 City z State 1 �" Zip�31�/
Office Phone: W =Q,05 Cell #791,97(0- S&ISFax # xf?1)19',94 �7E -mail i�J1fD�` �'16- V;9911 146, (XrG
APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, nupibDqr US ts, available arking spaces, number of
vehicles, and any additional information that you can provide: �j°, U :sn bi�JG>
*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 ave 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 b t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
C [S
Signature Printed 6-A&—
Zoning Official
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:
YIUIs us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y / a.
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 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 # 1
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verifie Mini he eld:
Insn ato L/ Date:
N
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