HomeMy WebLinkAboutCLE200900164 Legacy Document 2012-10-01Application for Zoning Clearance
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CLE # 20L)q — /(DC
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Zoning Clearance = $35
OFFICE USE ONLY n
Check # / 2 ✓ Date: '
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PLEA99 REVIEW ALL 3 SHEETS
Receipt # o S(9 Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 4 Existing Zoning
Parcel Owner: T "e-
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Parcel Address jj(— ?iC4 ch dt State 114 Zip Zj236
(inch] suite or flo r
PRIMARY CONTACT
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Who should we call/write concerning this project? 1�-�
Address: 67d OGk-tr c3eA04f60't fC* -Y City G4.fjoH,90,I16tate 04 Zip
Office Phone: ?Cell # �Fa # 29� - 4`99° E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: tN t- Ca l ��� 5 9 C L/
Previous Business on this site MOf ��(a d •G L�c�/'t �GI I'1 -®
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:
3 m .-) • w' 44o s
*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 accurat to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature`= Printed
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baclflow 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 PIP.
his site complies with the site plan as of this date.
Notes:
Building Official e Date (� �-
Zoning Official Date
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 u LI, HI or PDIP zoning? If so, give applicant a Certified
Eng eer's Report (CER) packet.
Y/N
Wil re 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 !�—M ( ) Le V,
berm tted as:
Under Section: a�•
Supplementary regulatio s section:
Circle the one that applies
Is parcel on private well or -Ic w ter?
Parking formula: ,-nI
I /„ZO 0 P
If private well, provide Health.Dap6tment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Items to be verified in the field:
Circle the one that appl;�;
Is parcel on septic or p ?
Va i ce:
Y N
If s st:
Y/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector • Date:
Y / N
Notes:
Will there be any new co struction or renovations?
Clearances:
If so, obtain the proper ermit.
Permit # 060 '5 gz)-�
Zoning to complete the following:
Viol . ns:
Y/
Ifs , ist:
offers:
VV N
]] so, List:
Va i ce:
Y N
If s st:
SP's:
�N
o, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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