HomeMy WebLinkAboutCLE200900189 Legacy Document 2012-10-15Y �
PARCEL INFORMATION
T5ael Q,/A-Jra� x Map and Parcel: 0 ✓�`�vl Existing Zoning
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kahrelthess:—:350 Is�CO� ►'(;�7�, 1�r, City h)a r10 ky& State Zip %no
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
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Address: �U r-nx, S' mi,� �� City IFAJa4 -Sv1 Jlt_ State Zip
Office Phone: (f3q %7' AI; Cell # qLQ -0UP Fax # E -mail
APPLICANT INFORMATION
Check ariy,that _ app, ly. Change��6f ownership Change'of use Change of;name New business!
Business Name /Type: �1n T, l —r� / awe C, ti� t � �VI 50 , /
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Previous Business on this site li �� d 1�°J� –� -e re /
Describe the proposed business including use, number of employees um er of shi ts, available parking spaces nu�►}ber of
vehicles, and any additional informatiothat you can provide: t��%�Q a –
t2 IM t/,7 -t .' M D 0 0 n I t n /e.. rto 4-r L ck. , (,91)1_0 t4i 0 q. vKF,S
*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 Gvt.�.- (,7L0r.ti./'l Printed r�irfgce� �� AA C"i CAL,
Y
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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:
Is /
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 ubli ater?
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 appl'
Is parcel on septic o public ewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit
Permit #
Y /N
Will 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: --(8, l a
!X)/N
Permitted as:
Under Section: 2AWm
Supplementary regula ions section:
40a
Parking formula:
l
0 11-A 4L
Required spaces: Lt
Y/N
Items to be verified in the field:
Inspector :_
Date:
i 1001
Violations:
Y/
Ifs ist:
Proffers:
Y/
If so, ist:
V ian e:
Y /
If s , List:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3