HomeMy WebLinkAboutCLE200900179 Legacy Document 2012-10-11Application for ZoniinF Clearance~
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Clearance = $35
OFFICE USE ONLY
Check # �� (� Date: 101;9_0'0 q
PLEA&Zoning
REVIEW ALL 3 SHEETS
Receipt # Staff. —1 Aff
PARCEL INFORMATION
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Tax Map and Parcel: 0 32 00 - On - oo - 031 A 1 Existing Zoning 3'f G — 'I (_0NM
ParcelOwner: SUIUS�-,f 1A,G - "' M 4 1:4W1 4 NQo0l VA144a
S£IV►IN CQ(hMorJs S a�P�N br c
Parcel Address: 3 0 S IbLO ri J)q SlA lf�, City CMRLa IS AIA)� State A Zip 2mL,
(include suite or floor) log,
PRIMARY CONTACT
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Who should we call /write concerning this project? V=� o (& G
Address : R22 Qbb bgQ o,k R.b city C — AK4 State V zip 229
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Office Phone: ( ) Cell # # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: B A B 0 (A S / B IC S 1 Y S S %60 iA p
Previous Business on this site SUM S M `P kC !^fair dAA! A-,C�"i S 02L
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: Ui'1.� k Cln I�nf1 SlVg~.1�
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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 accurat best of my knowledge. I have re d the conditions of approval, and I understand them, and that I will abide by them.
J0ri smw1
Signature S a Printed
aN W669 YR u '
A OVA ORMATION
[ L4 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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. bd
Zoning Official Date Id 7ZJ (�q
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, 10/13/09 Page 2 of 3
Intake to complete the following:
Y�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /NO
Will there 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 water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app lie
Is parcel on septic oZfublic sewer?
Y / N
dit ll you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 16 C) D
/N
as:
Under Section:
k p
i
Supplementary regulatidns.section:
Parking formula: /� a �4 %
/
Required
V/ N
Items to be verified in the field:
Inspector:,
Notes:
Date:
Violations:
If so; List:
Proffe
If sot:
Variance:
Y / N
If so, 1st:
SP's `"
Y ��r4
If o, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3