HomeMy WebLinkAboutCLE200900133 Legacy Document 2012-09-10Application for Zonin Clearance
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CLE #106q `'
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El Zoning Clearance = $35
OFFICE USE LY
Check # c� 0 Date:
PLEAS REVIEW ALL 3 SHEETS
Receipt # Staff. <I ff 0J
PARCEL INFORMATION
Tax Map and Parcel: 99 _1?) Existing Zoning
Parcel Owner: �) Qh C- p r� vuS�,Alvz o�
IS
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Parcel Address:-q,53 D Mo n aca >1Tra i I Q . City No ChM � n State VA Zip ,)@q5q
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? DCl1(1 - �]1Nf;l lii��
5501 Cove.Gaec(eet f-d.
Address: City C D ye s V t l e State VA Zip aa93 f
Office Phone: (y, , a 9,1 - qi1 y-J Cell # i LAQ - 9731 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
j
Business Name /Type: C Q u l t S C-s r oc e r y I Ll o 11 y e Yl 1�o, Y1 G o 5A- o)r -o°.
Previous Business on this site cYtWl Q�j G 1JG
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: L"m dlo vee-S - a ' Sam l-S --9....
*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 5'1 e r t y We-t-1-C.5
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 ( cC (,31 l
Zoning Official Date g/ D
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 Square footage of Use: / :� J D
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
ermitted as: AJN („ tArn' c6d v (-C/
Y/O
Will there be food preparation? Under Section:
�
i
- 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
7.nninv to rmminlPtP the fnllnwinff!
Vio -0ns:'
If/(NJ
If so, ist:
Circle the one that a lies
Parking formula:
Is parcel o rivate well r public water?
If private we , provi e Health Department form.
SP's:
Y;
If s , ist:
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/
SDP's
Circle the one that applies
Is parcel on(EDDr public sewer?
Item o be verified in the field:
Y /(S
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /O
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nninv to rmminlPtP the fnllnwinff!
Vio -0ns:'
If/(NJ
If so, ist:
Proffers:
If/
If s o,\M st:
Vari ce:
Y /
If so, gist:
SP's:
Y;
If s , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3