HomeMy WebLinkAboutCLE200900089 Legacy Document 2012-08-31Application for Zonin Clearance
CLE # "'g—O C ---1 y
x
OFFICE USE ,ONLYO
qi 3 (e Date:
LZoning Clearance = $35
PLEAVIEW ALL 3 SHEETS
Check #
Receipt # —5 J Staff:
PARCEL INFORMATION nn
0 - :5" C,
Tax Map and Parcel: C(p [ V O -- O [ - 6 U 1 Ex Zoning .-L
i% >1isting
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Parcel Owner: ��1111MCe � I q w�:x J
Parcel Address: �I < I� City �IM�(U��tt State V iS Zip �i22o i
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : /� LAS t (iL� `! City l /tVW UvV— State y zip 7116
Office Phone: ( Cell # �31'�� Fax # Cn')- 015? -E -mail C ,(X"i eMU�Vi-n S.0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:. Nl rM1 �A�J
Previous Business on this site
4.
Describe the proposed business including use, number of employ number of shifts, available parking spaces, number of
is
vehicles, and any additional information that you can provide: kv oyr c
*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 th II own or have t e o� `s �rmission to use th space indicated on this application. I also certify that the information provided
is true a ac ur to the best of y k, o ie e I h ve read t ions of approval, and I understand them, and that I will abide them.
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Signa re / Printed A - Af--
APPR VAL INFORMATION
.
[ ] Approved as proposed [ fV 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 cif this date.
N,otes:
Building Official 1 ' Date
Zoning Official Date /l?i�b `1
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 / tF-
Is uri LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil /IVp 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 p Cunti w ter?
If private well, provide Healt ment, form.
Zoning review can not begin we receive approval from Health
Dept. FAX DATE
Circle the one that apples
Is parcel on septic or p blic se er?
Y/N
Will you be puttrh7 a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a new construction or renovations?
If so, obtain the p per Permit.
Permit #
nmm�la+o +hn fnllnwina•
Reviewer to complete the ��following:
�
Square footage of Use:
P-efmitted as:
Under Section: 2i•7,-
Supplementary regulates section:
G
Parking formulN -1 ..
Required spaces f
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ions:
Y /.
If s , ist:
Proffers:
Y /�`
If So; List:
Va> is ce:
Y
If so, List:
SP's
Y
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3