HomeMy WebLinkAboutCLE200900149 Legacy Document 2012-10-01- - -- Application for Zoning Clearance
9
CLE # 00
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15 Zoning Clearance = $35
OFFICE USE ONLY j D
Check
PLEASE REVIEW ALL 3 SLEETS
Receipt # 9-{i Staff
PARCEL INFORMATION �y
Tax Map and Parcel: Existing Zoning
Parcel Owner:
i� f_
Parcel Address: j�l,(� � ,QJ City ���c riC$ il` State ° t ° 4l ", Zip':42!111
(include suite or floor)
PRIMARY CONTACT q (( Q
Who should we call/write concerning this project?
Address: ` ZW M V*4�s�s�.o� �it'9 City C ��," ,��� State ° l ` ZiP oa
Ofiace Phoue:� `19SZ5W Cell #a 2 Fax #`Rl E -mail `cr
APPLICANT INFORMATION - - - -- - -- - -
Check any that apply: Change of ownership Change of use Chang/e� of name New business
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Business Name /Type: �y i ��gr_c. f.M .- to v�r 1 � \� � X37' 'r �,o® I' V. a,--1 v' Q s..� ;s -
e
Previous Business on this site V�v® Q, �.i �Ca � u��,e?� ,� °+�� sa°" bW'1 T-
1% 14
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:
(CJPI°-�
*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
APPROVAL ORMATION
�-T 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 thistlearance. 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 Offici Date
Zoning Official Date 9
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: Reviewer to complete the following:
Y /(N Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y / N
Permitted as: AJ Y i f
Y/ N
Will there be food preparation? Under Section:
If so, give applicant a Health Department form._
Zoning review can not begin until we receive approval from Health 1 Supplemspt regulations section:
Dept. FAX DAVE
Circle the one that applies
Is parcel on private well o ublic water
If private well, provide Hea Department farm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o public sewer?
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
-- -- - - -- -- - - - -- ------------ - - - - -- - --
Y Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the fallnwinu:
Violations:
Y/
If s , ist:
Proffers:
Y/N
If so, List:
-MA
Varia ce:
Y/
If so, ist:
SP's:
/N
If so, List:
� 2
Clearances: -- ---- -_
SDP's
Revised 04/28/08 Page 3 of 3