HomeMy WebLinkAboutCLE200900132 Legacy Document 2012-09-10Application for Zonin Clearance
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CLE # G " b �
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Zoning Clearance = $35
OFFICE USE ONLY p /
Check # Date:
PLEAREVIEW ALL 3 SHEETS
Receipt # %(.e 6 `1 '3 Staff:
PARCEL INFORMATION y j
Tax Map and Parcel: 3 7/7 -1- Existing Zoning
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Parcel Owner: l/''(,
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Parcel Address: ��J / r )�/' / �✓V 5 ��li'- City � J State U Zip��'/I(J I
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Ji e n - -H-oa'
Address: 34 Se kA i nr, �� : cc�/ �e_ /obCity Cpl o, State 1) Zip 229/
Office Phone: O� 971 1' Y Cell #C.P � 10!V2-zoax # 471 4888E -mail
APPLICANT INFORM*TION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: tz /1%I f S
Previous Business 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: �'e ru,
*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,, and I understand them, and that I will abide by them.
Signature '� Printed V -Gri Pzarz
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 � l o`1
Zoning Official 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:
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Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
f
Y / jNJ
Will ere 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 o public wate
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or public sewer9
Y/�
Will-you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit # - - - - - - -- - -
Y /1N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninn +n 4ha fnUnwincr•
Reviewer to complete the following: /
Square footage of Use: t-/ D 6
1)/N
Permitted as:
Under Section: �Z- q, 2 • ��
Supplementary regulations section:
Violations:
N
so, List:
roff s:
„If so, List: G. � D I-AlrA
Vari ce:
Y/N
If so List:
S 's:
5Y /N
If so List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3