HomeMy WebLinkAboutCLE200900106 Legacy Document 2012-09-07Application for Zonin Clearance
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OFFICE USE ONLY �
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Zoning Clearance = $35
Check # Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # 7 5�1 �'}' Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning Co Wow\ E' v CG
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Parcel Owner: W 1 C
Parcel Address: 13IUe Gt,05e &&,City` t� I�ZP,k State U 0. Zip
-- - (include suite or floor) -- -- - - - -
PRIMARY CONTACT
Who should we call /write concerning this project? M a.vna
Address : `JAS+ 3cl CTl `�ibp !E ' City `Cr- c,MP.-i' State a Zip ��3Z
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Office Phone: L_) Cell # T3 q0- Fax # E -mail d $ 444 n r fL! Gh? k
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APPLICANT INFORMATION
Ch ck any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Q0_5 15—z1r C. P!
Previous Business on this site I yt€� V V 0.rC� I w2.� ae%! Ah G at�1� S �� x ►�
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: U -(o v
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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, I understand them, and that I will abide by them.
land
Signature � QE2/— Printed M 0- ut S • s1'Vlt+11
AP OVAL 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:
Building Official A� Date
Zoning Official Date Ifrf
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: _.. _ ___ _ .. _.. _ . Reviewer to. complete.the following:..
Y / NN Square footage of Use: c�'"5�
Is use LI HI or PDIP zonin g ? If so , g pp give applicant a Certified
Engineer's Report (CER) packet.
ermitted as:
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Will tFt be food preparation? Under Section:
— If so give a ppl- icant a Health Department form -- - -- -- - - - - --
_ -- - - -_ - -- -
Zoning review can not begin until we receive approval from Health Supplementaryregull tions section: -
Dept. FAX DATE t C{
Circle the one that applies Parking formula:
Is parcel on private well or pp,bfrc w er? 1
If private well, provide Heal , e ment form.
Zoning review cannot begin until we receive approval from - Health- Required spaces: _
Dept. FAX DATE
Y/N
Items to be verified in the field:
Circle the one that applie
Is parcel on septic or p lic s er?
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 n construction or renovations?
If so, obtain the pr per Permit.
Permit #
Zoning to complete the following:
Viol ns:
Y/ ,
If sq; List:
Proff s:
Y/
If s , 'st:
Variance:
Y
If so, ist:
SP's:
Y/
If so ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3