HomeMy WebLinkAboutCLE200900115 Legacy Document 2012-09-10J
Application for Zoning learance
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CLE # 000 ✓ I I
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,Zoning Clearance = $35
OFFICE USE ONLY .�
Check # cf sS A Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # '7 W9 T Staff: • (-
PARCEL INFORMATION
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Tax Map and Parcel: Existing Zoning�Gi
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Parcel Owner: R;t>
Parcel Address: 0 )yS m 4✓ — City A /1 Te State VA Zip 2:q:;&
(include suite or floor) "
PRIMARY CONTACT /�� /lam
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Who should we call /write concerning this project? cl
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Address: �J /Yl � �� City ll lShc'i��GG!'G/ State y Zip G 4
Office Phone: t✓ ","1 R, Q 4Z ell # Fax # E -mail
APPLICANT INF04MOAON
Check any that apply: Change of ownershhip� Change of use Change of name New business
Business Name /Type:1 ✓
Business /J, � /VAV
Previous 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:
*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 the best be 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 J?z )4 Ylpl
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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, xl 19.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This sitp pomplies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date 8 l (2
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 / N�
Is u ` -rkLI, HI or PDIP zoning? If so, give applicant a Certified
Reviewer to complete the fo//llowing:
Square footage of Use: 315V
Engineer's Report (CER) packet. l N aR ��� _ /, r rs�
ermitted as: q (
/N
ill there be food preparation? Under Section:
If so, give applicant a Health Department form. - - - - - - -- - - - - -
Zoning review can no eg'n until we receive approval from Health Supplementary regulation section:
Dept. FAX DATE ✓i/ Q
Circle the one that applies Parking formula:e)Vl�p�✓1/!GI CP/VVfiiir'
Is parcel on private well 1' water?
If private well, provide Hea t epartment form.
Zoning review can not begin until we receive approval from Health _ Required spaces:
Dept. FAX DATE
Y/N
Circle the one that ap Items to be verified in the field:
Is parcel on septic or lic s wer?
C/1 N
you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #- -- - -- - - - - - -
there be any new construction or renovations?
If so, oboe r r Permit.
Permit # ,
7nnin4 to emminlete the fnllnwin¢:
Violations:
Ifs ist:
If
Proffers:
Y /
If so, st:
Varia ce:
Y /
If so, ist:
SP's:
Y /
if , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3