HomeMy WebLinkAboutCLE200900156 Legacy Document 2012-10-01� v f 20M 0001
Application for Zoning Clearance
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CLE # - `
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❑ Zoning Clearance = $35
OFFICE �O LY
Check # ` Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: V '�`� d xisting Zoning
Parcel Owner: 1A\ LL4:� lien
Parcel Address: 2 m ( Y City 6QW W00 �3 State V& Zip i, r
(include suite or floor)
PRIMARY CONTACT y pn
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Who should we call /write concerning this project? - - - --
Address: 1 �,� ®f V �i City O-" el- State Zip
Office Phone: 6A ( 2, Cell # SAMVi Fax # E- mailCl�G'� �7v1yS�,F�SI'(UAL �
APPLICANT INFORMATION
Check any that apply: Change of ownership of use of name New business
�C^,h_ange `Change
Business Name /Type: � Ei rA� �i (Ci t ` xt- �lv
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l�revi�s Business on this site
Prey Previous (,NNF 6 a0i v� f
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
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vehicles, and y additional- nfo mation that you can provide: 3 (,L'OT1'%o2-
*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 knowle e. I have read the conditions of approval, and I understand them, I will abide by them.
�and ?that
Signature Printed
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APPROVAL INFORMATI
[ ] Approved as proposed Aproved with conditions [ ] Denied
[ ] Backflow prevention device and/or current tOdatapneeded 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 complics with the to pla 1 as of this date.
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Notes: r -'
Building Official Date
Zoning Official Date_`}
G �
f-00
Other Official Date
County of Albemarle Department of Community Development
401 McIntire-Road CliArlottesville, 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 / Square footage of Use: jy1
Is ee i �I, HI or PDIP zoning? If so, give applicant a Certified
Ell in's Report (CER) packet. �' / N
-Permitted as: % G
Y/N
ill there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not b g ti we receive approval from Health Supplementary regulations section.
Dept. FAX DATE
Circle the one t a pplies Parking form
Is parcel on�p�ate well or public water?
If private w ll, oxide Health Department form. A
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Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the ones -a plies Items to be verified in the field:
Is parcel on e�tic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. Inspector : Date:
Permit # i
Notes:
Y/N
Will there be any new co struction or renovations?
If so, obtain the proper P rmit.
Permit #
z.oning to cum ieLe Mr, ivuUvriu
Viol ons:
Y /!N
If so,, List:
Proff
Y/
If so, 1st:
Vari e:
Y / l
If so,'List:
'
"Y N
)s st:
so, Li
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3