HomeMy WebLinkAboutCLE201200218 Legacy Document 2012-10-26Application for Zonin Clearance
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CLE # O I - 21
❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # 2blb Dater
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION -
Tax Map and Parcel: D,4 / y i o 2, d*ev Zf d 6 Existing Zoning 7- zf
Parcel Owner: P x,,- K L L- C.
v
Parcel Address: j , g 0 p 13 s �� ewt a "r City Z'Ag '+r L e / f State Zip A 2-16 /
(include suite or floor)
PRIMARY CONTACT /� ,=
6 b 1 e%, 43
Who should we call /write concerning this project? a �'
City f� Rate tea Zip
Address: .� an�. !g�- �- l��tar v Ci i!harL.,iT�sv�
'1"3
OfneePhone: (Y3 V) Q.,?& -33 `7 Cell #Flay- Fax# 179-7 ?gy E -mail —"
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _. Change of name k-7' New business
Business Name /Type: e '. er Ml X .v e-- -t 2. P L a e C 14 c L. a!y a b L t &/ d1 v e c-d; �
s'r - ,rvrctF- 14/Ms- 799LLS 7�
Previous Business on this site Me. L a ,,, a 'k L 1" N Ai. P ti-.o d1 z , � Ts
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: j o, b /tom t� t -E, tX r5
-C sirh Lzc� aff 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 t � ner's pe 'ssion to use the space indicated on this application. I also certify that the information provided
is true and the best of wledge. have read the conditions of approval, and I understand them, and that I will abide by them.
accuto
�Apby 5h4T �,90
Signature Printed
APPROVAL 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
Zoning Official Date
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
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Intake to complete the following: _ - _ -
Y / 0
Reviewer to complete the following:
Square footage of Use:
Is use in LI, M or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will re be food preparation.
/ N
e kziAvens
Under Section: 2L/,2./ �17�
-If so, give applicant a Health Department- orm- - - --
-
-
Zoning review can not begin until we receive approval from Health
Supplementary regulations sections
Dept. FAX DATE
Circle the one that applies - _
u lic wa r?
Is parcel on private we 1'6"
Parking formula:
Required spaces:____
� -- - - - - - - -. -- - - - - - -- -- -
— - -
If private well, provide e h D ent form.
- Zoning review can _not begin until we receive approvalirom- Health_
Dept. FAX DATE
Y/
r
Circle the one thatlapp ' s _
Items to be verified in the field:
Is parcel on septic or ublic sewe .
Y/N
Will you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit.
- Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nnino to comnlete the fnllnmino:
Viol tions:
Y/O
If so, List:
Proffers:
Y/
If so, st:
Variance:
Y/(
If so, List:
SP's:
/N
trf so, List:
Clearances: �
SDP's
r
Revised 04/28/08 Page 3 of 3