HomeMy WebLinkAboutCLE200900174 Legacy Document 2012-10-11Application for Zoning, Clearance
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CLE #
1'�RGIN�P
Clearance = $35
OFFICE USE QNLY
Check # Z�(2,� Date: '
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PLEA6Zoning
REVIEW ALL 3 SHEETS
Receipt # �(� (' % Staff:
PARCEL INFORMATION
A
Tax Map and Parcel: ZAA1 0 t —r& Existing Zoning
y
Parcel Owner: ro O /1J (` 7 '" Z• S-1 7
Parcel Address: J City (/li0 State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
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Address : 3as ` �� Caj^t, VTe ! oti City (i V State d� Zip
Office Phone: C Cell # C (OPD Fax # 3" 76 E -mail
APPLICANT INFORMATION
Check any that apply: of ownership �_ Change of use Change of name New business
.,�C�haange
Business Name/Type: Crbis i �-C (`'t- / M)iYln4 +43t
Previous Business on this site
Describe the proposed business including use, number of employees, number of s if s, a lable parking s a .es, umber of
vehicles, and any additional information that you can provide:
*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.
Printed �I4 vvt ta Y, -( F11i+
Signature ., - /cw
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APPROVAL INFORMATION
[ ]'Approved as proposed [ ] Approved with conditions [ ] Denied
['' ] Backfiow 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 �— Date l
Zoning Official Date 91,
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
0
Intake to complete the following:
Y /N`
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /N)
Will there be food preparation?
If so, give applicant a Health Department forin.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies Parking formula:
Is parcel on private well or public water?
If private well, provide Hea tgibepartment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y AQ
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
'Y')/ N
Permitted as:
Under Section:,,. ivy, ✓ t�,�A c "1 1-
Supplementary regulations section:
Zoning to comnlete the following:
Inspector Date:
Notes:
Violations:
Y p�)
If so, List:
Proffers:
Y /fN'j
If so—, ist:
Variance:
Y /f�
If s(�; List:
SP's:
Y? /N
If so, List: �>
C`
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3