HomeMy WebLinkAboutCLE200900131 Legacy Document 2012-09-10Application for, Zoning Clearance
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Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Check # S Date:
Receipt # APQ 7 Staff: ( 1-17 W
PARCEL INFORMATION r n C
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Tax Map and Parcel: Existing Zoning
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Parcel Owner: `�f�(�lvY
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Parcel Address: City Wei State Zi�
- (include suite or floor) -- -
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: ;` �—� �� (� C— { l City k(1/lS,'tr VX 11 State v Zip �3J
Office Phone: � d� ®� Cell # M -5 Gil -QP3 Fax # E- mailgcQ�i coo U d m ck py-O C'�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: U('()
Business
Previous on this site
Describe the proposed business include gzse, number of employees number of shifts, available parking spaces, number of
vehicles, and any gddit'onal information/that that you can provide: kVz,11 Sa eS 0 `n ck � 46k- ctn
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*This Clearance will only be valid on fhe , arc 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 III ,owner s permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate to the best knowledge. I have read the conditions of approval, and I understand them, and that Iyy will abide by the
Signature q Printed
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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:
Building Official Date f� [
Zoning Official i Date
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 N'
Is us m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will e 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
Circle the one that applies
Is parcel on private well publiFrtmen't If private well, provide H form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic pu lic se r?
Y / /l
Will ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # - -- - - - -- -
Y
Wi re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnlPtP the fnllnwina-
Reviewer to complete the following:
Square footage of Use: 50
(b N
Permitted as: 7-Q-fA)
Under Section:
Supplementary regulations section:
Violat'ons:
Y/0
If so, List:
Proffers:
Y /`�
If so, ist:
Van ce:
Y/
If so, List:
SP's:
M/N
so, List:Z
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Clearances:
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SDP's
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Revised 04/28/08 Page 3 of 3