HomeMy WebLinkAboutCLE200900186 Legacy Document 2012-10-15Application for Zoning Clearance
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CLE # �Q �— TO(0
Zoning Clearance = $35
OFFICE USE O Y f rJ n v q
Check #� Date: G' G
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: Kj
PARCEL INFORMATION j
Tax Map and Parcel: Existing Zoning
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Parcel Owner: /
-316AOA
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT /�f� ^-
Who should we call /write' concerning this project? 04 `I" V IQ,1,>)
Address : I �/% 3" Vy10 J2d 4! uO9 City �a�,�i,��O k5V Ae- State !i� Zip ZZpa
Office Phone: - Cell # rg7l70'1 Fax # E -mail Ma )4,h ,n1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
-
Business Name /Type: d 4'V1ST atr(�'-Q U
\
Previous Business on this site
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: p syoc: do, &,51 . -,r F7- eoglo oa.� f eey—
*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 I have read the conditions of approval, and I understand them,, and I will abide by them.
/knowledge. /th/at
Signature -'/ i��(/ Printed �Ce. ��ebti7 �"!� pq
AY;'ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xtt:9: I l +
[ ] 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 ZG q
Zoning Official Date -ZD
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:
Is/
Is us au, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /.
Will sere 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 of ublic water?
If private well, provide Hed t1ep i
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or li ewer?
Y /
�1
Will you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit.
Permit #
WilMf%re 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: 3t) D 0
/N
-Permitted as: -WI
Under Section: _ �, Z
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ' s:
Y/
If so st:
Proff rs:
Y/�
If so, ist:
Variance:
Y/
If so, st:
SP'
Y/�,D
If so, List:
Clearances: /
SDP's
Revised 04/28/08 Page 3 of 3
OCT 2 2 2009
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