HomeMy WebLinkAboutCLE200900093 Legacy Document 2012-08-31t
Application for Zonin Clearance
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PARCEL INFORMATION
TMFA'o556-01-00 - 000 CO Existing Zoning
Tax Map and Parcel: S lour -1
Parcel Owner:
—01M(64
n 2293
�2A • &,dc C►'d2L4 01 Zip
Parcel Address:-/W-6 ett)10f City State
(include suite or floor) 0 L T(U I L Vi,L.1,4 C» cep, k,-
PRIMARY CONTACT *�
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Who should we call/write concerning this project?
Address: 06X 310 q City Cxoq-e-� State A Zip ZZOI .?
Office Phone: (! $2 ,3490 2 Cell # f'�V' 2417- -Ad ax # E -mail zo ii. $e9 - d //e
APPLICANT INFORMATION
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_.. *j-¢i 3: ,�': �,°"%knn`+o1' tail mar s3Y i"N .:.F'i' v rhi�' S a+..§ Y aF4`{'ry j7'd,`i^t.,Y 241:.i. �'7 a' ✓,i' 4L �1S�` MUM.,
Checic,Any, thatapp1y4,3Change o�pW,nre�rsliip Clian�gne Qfuseyf�GharngehoNew,fzustness.
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Business Name /Type: 1 n C . �`a WA �f _✓a 1le5.
IUD/lp- - /VW cons Al c 4 0-2•
Previous Business on this site
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: 5A le e w r0 5 4L4jb Le..A0j0qe
1.i %r� a0 buSr'atX5 vehr'665 42A HW5 -6N, / A k1" S ells .
*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 have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true an accurate t the est of my knowI d . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ! 1 Printed �/U/�iL� �. /�IG'GI
APPROVAL I�tFORMATION
[ ]Denied
[ :] Approved as proposed, , [tA roved with conditions
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[ ;,];Backflow prevention device and/or current testVdata needed for thisflsrte Contact ACSA; 977 451l,�xlsl
[ -,] No physical site inspection has been dons Ifor this clearance Therefore, it is not a determination of compliance with the;exis "ting .'
site plan k
[ ] This site
OF with the stte,plan as ofthis da e
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Notes.
Build ing °Official' Date.
Zoning Official :'
Other Official Date'
nc xffiv py ynu v.� �.,:
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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ake to complete the following:
Y /O
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /®
Will there 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 pub
If private well, provide Healt form.
Zonin g review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
,V / N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: I &, -7 5
YIN
Permitted as:
Under Section:
Supplementary regulations section:
(, Q
Parking formula: ,
Required spaces:
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y Q
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Notes:
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Violations:
y
If Oist:
ffers:
N
o, List:
Varia ce:
Y /N.
If so, List:
SP's:
IN
f so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3