HomeMy WebLinkAboutCLE200900157 Legacy Document 2012-10-01nj�
Application for Zoning Clearance
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CLE # Z0Cx1 " / 5-
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Zoning Clearance = $35
OFFICE USE ONLY y "09,
Check # Date: lj
PLEA REVIEW ALL 3 SHEETS
Receipt # -- s Staff: (,(i
PARCEL INFORMATION
a ('0441V , Tax Map and Parcel: 0 ,(f CJ �`v - n " C� � -- 6 0 / ' � Existing Zoning vl
Parcel Owner: (( 4„r
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Parcel Address: 3 3 0 l M, "AI,jP'lAk city � �(r �p`E1-�tiJ; ��� State Zip az
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(include suite or floor),Zol-flope
PRIMARY CONTACT 1
Who should we call /write concerning this project?
Address : �� (� Lm"n00 (')MA City .r—hr" (66w,` State U G Zip oL2�►U
Office Phone: Cell # 6,0i(- S6,1 -lll ?S Fax #X166 -907 WQ E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: rms fi r I/ /i rc j1 V%1 rn- �-e.o. C,'�� ��► -kuv„ e rau ecyld,�_r Set!/,`[
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, any additional that you can provide: S acaN cc a �J eel 1'�'►- (- Se N P-61S4120 4 Sh l- !
pand
fi'nformation
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*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
AP OVAL 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 r Date j c>
Zoning Official Date 1 d 6
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 Paga,2 of 3
1
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Intake to complete the following:
Y /p
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
WA4hi6re 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 i er?
If private well, provide Health Qqxrrtrnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap p I*
Is parcel on septic or p tic s er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. \I
Permit #
Y/N
Will there be any w construction or renovations?
If so, obtain the prop Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: ) oIO O
/ N
Permitted as: -�1
Gtr
Under Section: a,� oZ 1
Supplementary regullaatInssection:
Parking formula: ) ).2- 0 (3 yL49--
Required spaces:
Y/N
Items to be verified in the field:
Inspector Date:
Notes:
Violat,t'Qns:
If /(N J
If so, st:
Proffers:
Y /
If so, ist:
Var' ce:
If so, ist:
If
SP's:
Y /�
Ifs , st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3