HomeMy WebLinkAboutCLE200900173 Legacy Document 2012-10-11Application for Zoning Clearance
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CLE # — IM 3
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El Zoning Clearance = $35
OFFICE NLY y()
Check # 11M I Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATIO
Tax Map and Parcel: D (.Q o OD of) 1 ,1�-� 0 C) Existing Zoning
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C 't� S D C.1 a `t>✓�
Parcel Owner:
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Parcel Address: V-4 -D �_C , E City � � ��y �5 j f ate VA Zip g�920)
(include suite or floor)
PRIMARY CONTACT 4"s
/write �(ai�/rl
Who should we call concerning this project? �.
Address &X 'S City (' �� tjalj State Zip 2a,
Office Phone: ( (p g Cell # ,53)- U Fax #d`lb - 1 )1 E -mail 6P
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 'Q
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Previous Business on this site cl?
Describe the proposed business including use, number of employees, num er of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide:
Or, r Vi., c I r, &A .
*This Clearance will only be valid on the parcel for whicl it i approved. If yo change, rte sift' 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 pern4ssion to use the space indicated on this application. I also certify that the information provided
is true and accurate the best of my knowledge. imave read tlme conditions of approval, and I understand them, and that I wil abide by them.
Signature V \. Printed z,__ 9
APPROVAL INFORMATION
J,- JApproved as proposed [/J 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. 46- ) X11 Q f[ Y
A16 I%e-A1 P'� Y ,4l �o W
[ ] This site complies with the site as of this date.
plan
Notes:
Building Official Date I of I )Ja�
Zoning Official Date ,i�) /.�y�y 9
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 use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi ere 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 o • ublic wit H
If private well, provide Hea h-H partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one thata
Is parcel on septic or Iicse ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
0 il N
l there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # n9 --- /'7 53 7
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use:
N
Per
Permitted as: _e�V
Under Section: 4Aq4;1L,. Yf1 C, S
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Ite o be verified in the field:
Inspector : Date:
Notes:
Violations:
U/N
If so, List: � // � ����
Proffers:
Y/A
Ifs , ist:
Variance:
Y/ /l
If �, List:
SP's:
If/�
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3