HomeMy WebLinkAboutCLE201200216 Legacy Document 2012-10-12iAa
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Application %r Zonin Clearancefr,.f`'`
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: g �
Receipt # �J' 7'x"7 Staff:
PARCEL INFORMATION ,{ /
" dd -6o -15115 Existing Zoning
Tax Map and Parcel: % I
Parcel Owner::
Parcel Address: I (,(7C) c 21r� c>Pid �vifil� 1 City G }�A �G r State t0 i� Zips���
(include suite or floor)
PRIMARY CONTACT 1
Who should we call /write concerning this project? r�
vCity.
Address: 5± State A Zipt -i
Office Phone: 6�6� �gq--2yyg Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Changes of use Chaangje�of name _,/New business
Business Name /Type: CAAU�,✓_ A S &NA lG ->Arr) <`.-T �
Previous Business on this site ,) A
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:
M rC
*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.
Signature Printed C j � 2 1"5' Z)g1SSR
APPROVAL INFORMATION
, )<1 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 i 1 rt f I �L
Zoning Official (.�`° Date�a�� . ✓'1'� d'%✓
Other Official Date
County ot'Atbemarle impartment of t:ommumty vevelopme-
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y I
Is use ' LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Will' h)e 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:��
Permitted as: "+4 £
Under Section:
Supplementary regulations section:
Circle the one that applies flaming rormuia: '?
Is parcel on private well or( ublic'
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p blic sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
I, / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to com lete the followin
Violations:
V)' / N
If so, List: A14
Promff s:
Y
If s
Variance:
Y/N
If so, List:
SP'.
Y
If so, is
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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