HomeMy WebLinkAboutCLE200900183 Legacy Document 2012-10-15Application for Zonn Clearance
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CLE #
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Zoning Clearance = $35
OFFICE US ON Y y� r
Check #� Date: c li! f�
PLEASE REVIEW ALL 3 SHEETS
Receipt # M0, Staff:
PARCEL INFORMATION
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Tax Map and Parcel:7G C
,x WC, --5,a , P.—OrLgA 4t'(a i- tF ') Existing Zoning 1N1 ;�X p d (ice? ,
Parcel Owner: )Ao) I �(m ecj 1 n Le) n (.e.,m4 r LL-C, j �. �`�p��. �clre, (..% w, +,o c( L 1 c It1—LE-)
Parcel Address: '1 11 CowNyn Uvn i'4+( SA city IIe_ State VA Zips 1 I
(include suite or floor)
PRIMARY CONTACT ((��
Pa
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Who should we call/write concerning this project? )� t�ec? 4 c,5 �`; r Prtl1 v — UC e A-c ,
Address: P D P)nx 4�bc)n City ImGd, .")o i'1 State V A Zip
5va•-
0Mce Phone: (5y&))QLI6-_7 c�'J3 Cell # Fax #�'y�S- 7o��S2�S E-mail P q18 UCtCAkGS
lows?rS . Ca
APPLICANT INFORMATION
Check any that apply: Change, of ownership Change of use _Change of name � —New business
Business Name /Type: P � D 4J bt- H -ec ✓ 4\ I n e,
Previous Business on this site ))0k4,( WQL- t �/ iC6 PD5
Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 1 e.� +\ t {J� e /
S:. C1ce`a -- 110nL-_ G` '
*This Clearance will only be valid on t ie parcel for which it is approved. If you change, irate sift' or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify thatZ -e i or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accu to to th best of my knowledge. IIhhave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed I�j��r-E G
APP OVAL 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.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official �— Date l0���`
Zoning Official 1 Date b 122tog
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: Reviewer to complete the following:
Y/N
Is use in LI, HI r NIP zoning? If so, give applicant a Certified
Engineer's R (C R) packet.
Y/ in
Will he be food preparation?
If so, ive applicant a Health Department form.
Zonin review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or pu l w ter?
If private well, provide Heal 1 De tr form.
Zoning review can not begin' we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p lic sew r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # f
Y/N
Will there be any new onstraction or renovations?
If so, obtain the proper �rmit.
Permit #
Zoning to comnlete the following:
Square footage of Use:
Y/N
Permitted as: LCAL Q I/
Under Section:
Supplementary regulations se tion;
a
Parking formula:
Required spaces:
Y / N�
Items to be verified in the field: �
J
Inspector:
Notes:
Date:
Violations:
Y/V
If so, t:
offers:
/N
kso, List:
Vari
Y /N —'
If so List
Y/N
so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3