HomeMy WebLinkAboutCLE200900142 Legacy Document 2012-10-01Application for Zonin/ Clearance
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CLE # ,/��i� ,
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SIR IN0P
[Zoning Clearance = $35
OFFICE USE ix Y ,cyj�����
Check # / Date: V
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 Staff.
PARCEL INFORMATION /
"' Existing Zoning / >�
Tax Map and Parcel: i��
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1
Parcel Owner: ✓j Hz 1 � elht yy ���i()�iJl r / (d 6 �
U�� V '- Lr R.1111'I I (
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Parcel Address: b,00 v t V `& � City t'v u r State V 'iJ' Zip
(include suite or floor) _
PRIMARY CONTACT
Who should we call /write concerning this project? IN
Address : /-?g G 2 �a �U.Q7i..G Ltil .,. City G&yA[ -o rzT j LzeL kite V4 Zip 2 ? g%
Office Phone: Cell 2�, _ 17,kax # E -mail A,4V, I&.179t�e Yiir 4iL. Gory
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name i/' New business
Business Name /Type: R P� - a 6-,- e s s o f--1 e-!
Previous Business on this site %� r i z G✓/N(� �2, 4
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: 5�I— of ( Lo7 ;&-IA 4GGrt 5 sez,3 �
Ova ���OLoYi`�S, 1 1,114L�-
*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 havy the owls -p nnission to use the space indicated on this application. I also certify that the information provided
is true t best knowle have read the conditions of approval, and I understand them, and that I will abide by them.
and accurate of my g6
Signature / % Printed /1'/
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 a _
Zoning Official Date �t 0
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 /
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will �tere 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
Reviewer to complete the following:
Square footage of Use: I 1 00
ii tted as: `
'
Under Section.
Supplementary regulattiisection:
Circle the one that applies Parking formula']
Is parcel on private well or pu ter?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces: )
Dept. FAX DATE 5'�1�
Y/N
Circle the one that appli s Items to be verified in the field:
Is parcel on septic or pu lic wer?
Y/N
Will you be pW4
Sign permit.
Permit #
Y die
Will / re be any n
If so, obtain the pr(
Permit #
a new sign of any kind? If so, obtain proper
construction or renovations?
Permit.
7nnina to emminlPtP the f6llnwin4.
Violaft'Qns:
Y/ T/
If so, ist:
Pr ff s:
Y/N
Ifs , ist:
Var'an e:
Y/N
If so, st:
SP's:
Y /1
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3