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CLE200900123 Application
COMMUNITY DEVELOPMENTI Fax 4349724126 Rub 10 2009 11:23am P002 /002 Application fa Z uin Clearance � A CLE ^ ^xv5,=[:'-- �..u��' _- w{:�n ° °_urg :lai n: d at _::;a • ::sxrlt: .'._trav — .fir-;?; •�v,. .,'':'ic:f�^i %i: k:'. lLl �; tea`,_' ='n `�- � r -�� �E � . : � ' ,:�„ t. , �r•t• .�..:,'• - �,7fih , �_',._r'" zl�ly"rs• ,i � >J{' xv''/ �y _ � _ nn "1,: ...!c =i ,t - -. ar,_t,4 L�+'s'�I l: uy',� ,r `.,.. n- ir-_,' °_`�c�•._".`_!Ss6n_�•,-,,�c��?_ '{lux. y- - i:i• -- i,Wa"`�•„_.V .�su p9n - -:sx - alrutr �.•' :"i ;�w �- •' �a5�c n�`:�.�I+fiiu ✓ ��an .,R.�.:: :. ;?�L -,,:: _ _, ��•, y _EGp ;J' - �._:'.:'- �;;4'• :._ur�'i'- _.:._ -Irr � %: ''c:o':r . - . � =��6�i ' ���� � �9 � ; s�t ' - "�:.�.s`- •.?+�:.E�- - - nrr..m„�f„4�., .9i •,I m 'rb -� P_ ?:'a:nna9rv,iiw'• - - ' '- �q;�''i' ^'..��".:':4=4a'rr-_. .. •._- ^nr;�.':,W' ".:' "1 ":rWPmy .. _ �'�8 "�::�7 Yr. _ - - - al,iSliiir-ICm.'i N r &Ir.:•. PARCEL INPORMA ' .� �t)r�- �Al'Csj ` Ac �a lllfap an Fa.rcel: Ci Q� i ilJ °— "° E�istilug � img. 10 Ae / /"C Parcel Owner: 11 �1 1.��(%d' t t(?�/�/ `14A1, Parcel A.ddress:1 lo Lil�{4)Vr L'i1S '1'� Cite ''✓ oi: (5�/I6 "� State VA Zip � (ln elude suiti or floor) PRIMARY CONTACT Who should we call/write concerning this �' Address : &60 f t oil City State Zip ��C7yi Office Phone: ` vM2 Cell # q #- 37) Fax #7� r '2 E -mail q14 J «►L � �C//i�Y.IC!)LZ L'�%�r1L�u APPLZCAN'T INFORMATION r• a =rau:— = =iii w '_ . r:•_:; YI�II _ "° _ = _- "= ° =_;,.: "�_ Bess; ;. : Business Nanxe/rl'ype: n � j--1;l .. V Previous Business on this site Vescribe the proposed business including use, number of employees, nuxnbe of hi , avallable parking spaces, number of vehicles, and any additional iuformatio4 that you can provide: S CZ 911 K. *This Clearance will only be valid on the parcel for whioh it is approved. Ifyou change, intensify or move the use to a new location, a neNv Zoning Clearance will be required. I hereby certify that I own or have the oNamer's pennission to use the space indicated on this application. I also certifi, that the information provided is true and accurate t e best of my lai N d I have read to conditions of approval, and I understand totem, and,tha I will abide by thern. 7 signature Printed,Gi .. tta�'• .:rfy +' WI �i '�i, i. : �• - .r . t.`x::4.. ': .:. :.. ....n.. i'n ;b::'.i - J nr1X:J_. _ 'h uI T.G:iv ,. . ,F _.. p� :.:��.:� :s:p' � is 1.a��r_ - v.m•:�= :•.:I_. F•:!,, •' ^�' %n•: - yj.: xC ?'' ,'alli �Nr�i Jr:rl I'�nk +iLYwJlrr ��: : :Tr •. li1'C_., r ��Y r' l _ • - r." _ U •' =� -- y— �cl[..� .n1,)�{�yy: (.y� — nr_�r•— flu:: "': ,,;A'. w.n •. T._ ,.Gli.._.�.::. 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'ir,;; : •'am' - -• � _ ,__., f If., 4.,,.. x h - = -'ri 5 rr. "�.:__^.+' •'�i711v'i. � w.r. +' _. ._._` ��•- '.,_• •- w;�i ..- 7. -:" n� - - '.rp,�. "` � -- a; ' ���'r "`:•:M'r!,i'I�._ r•.�clr• ,- �.., :.•: .,.r. e .. ,' - w._... :_ rrnmlre... .. . _•: `, . __..._ ::.. —ems ...---" _ _ - -- r. I:Sr.:x �., . f _ _ w:m:xii;•: ...W f.. all .,... .Ittnl... ^�nn�rr.L.: .._, I �.._...::, .,._': �; :�:;�:.,:.; .,�, 4_._ .: a r.? ... mph. .V r. +�llCr:'..r:C::' "-'� . J` -• ^': slv" I_,:rn.:.; ^'t County of Al.berztarle Department or Community Development 401 lNlclAtire head Charlottesville, 'VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 04!28/08 Page 2 of 3 Zoning to comnlete the following: Violations: Y/N If so, List: Intake to complete the following: Reviewer to complete the following: Y Square footage of Use: Is fenr'�I�HI or PDIP zoning? If so, give applicant a Certified Ens eport (CER) packet. Y / N Permitted as: Y /N' ill there be food preparation? Under Section: SDP's If so, give applicant a Health Department form: Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that ap Parking formula: Is parcel on privy well or p blic water? If private well, pr vide Heal Department form. Zoning review cannot be until we receive approval from Health Required spaces: Dept. FAX DATE Y/N Circle the one that a lies Items to be verified in the field: Is parcel on septi r public sewer? Y/N Will you be putt)nn ign of any kind? If so, obtain proper Sign permit. Permit # _ Inspector; Date: Y / N Notes: Will there be antion or renovations? If so, obtain the Permit # Zoning to comnlete the following: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3