HomeMy WebLinkAboutCLE200900099 Legacy Document 2012-08-31Application for Zoning Clearance_
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CLE # 00 9 000 V�?
t'48;INIP
52i Zoning Clearance = $35
OFFICE USE ONL
Check # Date: -'111311-11
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PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: e,,, f P�
PARCEL INFORMATION - ' r
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0 � ' /4b F �
U Existing Zoning
Tax Map and Parcel: 116/
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Parcel Owner: C"r \mss
Parcel Address: 5 5 D St.YTltf\Ar,-, l.1 City State VA Zip
(include suite or floor)
PRIMARY CONTACT��
Who should we call /write concerning this project?
Address: L15 5 b �'Gii1,�l,t�lP� 1,tf' City l K \` ' State V t Zip
Office Phone: (Pi R- 2Z^6CISL Cell ACLSt tb3 "ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use ✓� Change of name New business
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Business Name /Type: W'C.,"C_. Q-QL _ �
Previous Business this �.�►� ��(1 ��,�C�
on 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: Qu 6Wem2 C=4,r. LZ c.mpLo ees) OR'G
S JAI) JvII:�5' f% (AMn t 2aAm Le prrm
*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 her y 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 a and accu e to the best of my k owled e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed l -f— Mq 1 ► , Rcir
APPR VAL INFORMATION
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[ ] Approved as proposed [ Approved ith conditions [ ] Denied
[ ] Backflow prevention device and/or current to t 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 comp ies with the site plan as of this date.
Notes: ' ✓ -A6 f 1WS 0 Ga_ ,t), Is
al T r n` • t�Irtd' 2
Building Official Date ' c
Zoning Official Date
Other Official D to
County of Albemarle Deparfinedt 6f Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
V31 1
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Intake to complete the following:
Y /
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Wi Ythere be food preparation?
If so, give applicant a Health Department form.
Zoning review can n begi unti
je r eceive approval from Health
Dept. FAX DATE �'�
Circle the one that applies
Is parcel on private well publi water?
If private well, provide Heat epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aapo
Is parcel on septic puMic 4ewer?
0/N L'i, 11 ffp)`'�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
PermiitOere #
Y / Will be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
3OO(D
/N
ermitted as:
Under Section: '2`�' � <,2. 1
Supplementary re lations section:
Al it 0�
Parking,formula: dad x A , i
Required sp :
�
Y/N
Items to be verifiej in the field:
Inspector : Date:
Notes:
Viol ►ons:
Y
If so, ist:
PrEN s:
If s, st:
Va 'ance:
Y7 T
If so, ist:
's:
/N
I so, Lis
Clearances:
SDP's
L
Revised 04/28/08 Page 3 of 3