HomeMy WebLinkAboutCLE200900155 Legacy Document 2012-10-01Application for Zonin g Clearance_ °�9
CLE# 200q-lSS- }�,�-
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Q Zoning Clearance.= $35.
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PARCEL INFORMATION
Tax Map and Parcel: ��� ii5�, Existing
Parcel Owner: lb
Parcel Address: ✓
(include suite or floor)
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PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 4,414 "X APt (t >lYt CCkP
Office Phone: (_� Cell #7�
_ •Date.✓
Staff•
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City �J1%� V �� State � Zip _
State M4- Zip �(�
E -mail
APPLICANT INFORMATION / /
Business Name/Type: E;h�V SS S- J /-Z-)
Previous Business on this site �At Lm VV N
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:
*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 hav the er's permission to use the space indicated on this application. I also certify that the information provided
is t :ue and a';cura o the best o mtp I have read the conditions of approva nd I understa d them, and at I rll abide by them.
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Signature A Printed
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 /O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(
Will IlTdre 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 or pu, 1ic w ter?
If private well, provide Health l&pment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies -
Is parcel on septic or ublic ewer?
Y/N
Will you be pu up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the prop r Permit.
Permit #
Zoning to complete the followinLY:
Reviewer to complete the following:
Square footage of User
P- rmitted as: I
Under Section: • o�°
Supplementary regulations section:
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Parking formula: 1 / A
Required spaces:
Y / N ` -
Items to be verified in the field:
Inspector : Date:
I
/ R
Viola 'ons:
Y/V
If s ist:
ProfVfer
Y/
If so t:
V ar' Ece:
If
If soist:
SP's
Y / N
If so ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3