HomeMy WebLinkAboutCLE200900097 Legacy Document 2012-08-31Application for Zonin Clearance
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t Zoning Clearance = $35
OFFICE USE ONLY
Check # 0001 Date: 6-0.
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PLEA REVIEW ALL 3 SHEETS
Receipt # 7 Staff. KGB•
PARCEL INFORMATION
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Tax Map and Parcel: /mil :d- Existing Zoning
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Parcel Owner: l ari1�' ✓ L' L� (�Lv
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Parcel Address: 12ot 57-oN�y 4tbGE -,Cg City ('G,ca,(n6%3,r,-kt State ,Z- Zip 2Zpo
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Vie, -r s,J (o (l w�
Address: 1 S 11 b It� I 1 L :D e— City rrA z_c % State \ I ,A-. Zip 2?_ r3Z
Office Phone: Cell # K3k%— Zell Fax # E -mail
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APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
++Change
Business Name /Type: v i 1� S`i - Loo*- - ' (�t r °• 51 1
Previous Business on this site d h� f�`i N ��!!.� /Yr9t� ""° Nr� el'4 and
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: r t w\it l S , . S ��e s i t . 2 - t/ r M10
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*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature -- Printed (.�'�
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:
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Building Official
Zoning Official s Date 9 /6 /
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
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Intake to complete the following:
Y /ICI
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/C
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
Reviewer to complete the following:
Square footage of Use: 2J li D
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Permitted as: &4; fife-44
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well or u�Iicwa r?
If private well, provide Health nt form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that app1;i
Is parcel on septic or p c eov ?
Y /CO
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
YM
Items -% be verified in the field:
If so, obtain proper
Inspector : Date:
�, Notes:
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violati s:
Y/
If so, ist:
offers:
/N
If so, List:
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Vary ce:
Y N
If so, List:
SRI
Y(N )
Ifs , Ist:
Clearances: ��✓ �
SDP's
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Revised 04/28/08 Page 3 of 3