HomeMy WebLinkAboutCLE200900205 Application Zoning Clearance 2012-10-15Application for Zo ing Clearance
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CLE #
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OFFICE USE ONLY
Zoning Clearance = $35
Check # Date:
1
PLEASE REVIEW ALL 3 SHEETS
Receipt # PITT Staff.
PARCEL INFORMATION..
Tax Map and P reel: Existing Zoning
Parcel Owner: (,04 W_
Parcel Address: City State Zip
(include suit or floor)
PRIMARY CONTACT
Lk) Ice—
Who should we caul /write concerning this project9
Address iA rkv\.,yCrAe_ City KA)� State Dc' , zip 6
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Office PhWe: � M rl 1 v 1 uu Cell # 41Ko Zq6 Fax # —� E -mail �,4eAjO��`(� -!�Q
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APPLICANT INFORMAATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: R'1t d'ymna 1` ��1\ A':n_ Pl2�
Previous Business on this site LLWI! % olt l� I't ne, 03 d— �-
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
v hicles, and any additional information that you can provide: c.- puw'kr�4e_/'tA Lt aS� a�v'� �►Z2�i
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*This Clearance will only bt lafid& the parcel for which it is a roved. 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 accu ate to the best of my knowledge. I have read the conditions of approval, and I them, and that I will abide by them.
�understand
Signature Printed
AP 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, 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 I
Zoning Official Date �'�
Other Official �f✓ � pp ffiate i 1,10
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
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Intake to complete the following: Reviewer to complete the following:
Y / N Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y / N
,o Permitted as:
7nninv to rmmn1ph- the fnllnwinu-
Violations:
Y/
If s , ist:
Proffers:
Y/N
If so, List:
Va nce:
YI
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3