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HomeMy WebLinkAboutCLE200900167 Legacy Document 2012-10-01Application for Zoning Clearance �_����m CLE # ;� _ f'IRr;iN�P OFFICE Y Zoning Clearance = $35 Check # Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFO Tax Map and Parcel:I�� u Existing Zoning_�� VII Parcel Owner:— n T° , AA p Parcel Address: A City _State Zi k*O (include suite or floor); PRIMARY CONTACT Who should we call /write concerning this project.a� /N Address: City/� 5 CO f ,�—A<' State I/ % . Zip Office Phone: ,j'3 r -02,9 (, Cell # Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business / Business Name /Type: Previous Business on this site` 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: C�, Pt' L- , bar 4-S '+ 70 <� *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 he owner's permission to use the space indicated on this application. I also certify that the information provided is true and accura the bee of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APP VAL 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. [ V],ihis site complies ith the site plan as of this date. Notes: C D �to9 t�1 b Building Official Date LO c- 'T 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 i. Intake to complete the following: Y /ON Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval fi•om Health Dept. FAX DATE Circle the one that applies Is parcel on private well ubiie at If private well, provide Hea epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septi or ublic se} r. YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there be any new construction or renovations? If so, obt ' er .t Permit # 7onin¢ to comnlete the followin¢: Reviewer to complete tth�ef�froollowinrg: Square footage of Use: �v v YYN Permitted as: �'�'1 L� 1-► n 'LSS� Under Section: Supplementary regulAtions section: Parking formula: ' /a©() Required spaces: YIN Items to be verified in the field: Inspector : Date: Notes: Viol , ns: Y /�N If so, ist: roffers: /N' so, List: V is ice: Y/N I so, st: SP Y If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3