HomeMy WebLinkAboutCLE200900209 Legacy Document 2012-10-15Application for Zon in I Clearance
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CLE # -P-0 � -
Zoning Clearance = $35
OFFICE USE ONLY
Check # /e; 7e," Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt Staff:
PARCEL INFORMATION
Tax Map and Parcel: !> '/' / YO — U D - 0 a — 1 0 j 0 O Existing Zoning �✓
Parcel Owner: e e 4 g a e. ' 4 /
Parcel Address:-, -r� l City L� ,�� Ile- State j/X Zip
(include suite�or�
PRIMARY CONTACT fr
/wwrite llcvv
Who should we call concerning this project?, .
Address : / (t'�� -( ( (,t,{' r/, ' / (/, jn f,�it� 1 City V' l C_ State �i L Zip '7 zQ1
Office Phone: C__) Cell # j 0` 6 Fax # E- mai15hCerzr , l urr?e,,3 W
APPLICANT INFORMATION
Check any that apply^ Change of ownership Change of use Change of name New business
Business Name /Type: Jam= JM I'D w s
Previous Business on this site /14f- -
Describe the proposed business including use, number of employees, number of shifts, avail�?le par ing spaces, number of
'
vehicles, and any additional information that you can provide:. L hZ ,'.c'Tr-
L7-V 0 1r'
*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//, o n or ]lave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate toy ie best of my kno 1 %dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
1
Signature ` /Win / Printed
JT
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A OVAL INFORMAVON
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ]�Aelcflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[.0o 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
Zoning Official Date �°y' l9
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, 10/13/09 Page 2 of 3
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Intake to complete the following:
Reviewer to complete the following:
Y /
Square footage of Use:
Is usevu, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Q / N
ermitted as: i
Will`ldre be food preparation?
n
Under Section: ,r y tA b P Ab
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
ktaoz
Circle the one that applies
Parking formula:
Is parcel on private well or p blic ater?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces: 1+
Dept. FAX DATE
Y/N
Circle the one that aim i
Items to be verified in the field:
Is parcel on septic or publics wer?
Y/N
Will you be pu up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / N Notes:
Will there be y new construction or renovations?
If so, obtain tl proper Permit.
Permit #
7,nnina to vmminlPtP the fnllnwina!
Viol ins:
Y /'t
If so, ist:
ffers:
N
If so, List:
put A
W ist:
�P's:
so, List:
%{ n
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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