HomeMy WebLinkAboutCLE200800028 Legacy Document 2013-01-03Application for
Zoning Clearance
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OFFICE USE ONLY ,� )� �j
oning Clearance = $35 CLE # (.� /'c (�,�j
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # tog ) 4(} Staff:
PARCEL INFORMATION y�
Tax Map and Parcel: Existing Zoning y
Parcel Owner: &E W S T r1 6 n )41 11
Parcel Address: I ci SQ 2N o �A `I 1 k Wcity State Zip
(include suite or floor)
Gig J I t� j
PRIMARY CONTACT �� c D
Who should we call /write concerning this project.
Address: yU IYd L ! zip e
Office Phone: �9�Cy Fax # E-mail R1y, ,6Y� 601nCe,97' y, e Z_ O �S
APPLICANT INFORMATION /
Business Name /Type: 5 �w�y7`�jeS s •- r'� to esS' Stu �o'S3
Previous Business on this site %7l� �l Q to
Describe the proposed business, including use, number of
additional information that you can provide: ihS i r.
*Thus Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission to use the space indicated oil this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature J Printed I J'irJ_ p''0y
APY,ROVAL INFORMATION - --
[ sy] Approved as proposed [ ] Approved with conditions �/4Ce ttlt�il /Or
[VTBackflow prevention device and/or current test data needed for this site. Contact ACSA, 77 I 1 .�st a$a Neetjeg
[ (/fNo physical site inspection has been done for this clearance. Therefore, it is not a determi aCo ct rp 41 �tl4�l gez�is�t>�
site plan. A
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date , -
Zoning Official Date �o b
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
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Intake to complete the following:
F-1 YES P NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report CER) packet.
❑ YES NO
Will there 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
❑ YES ❑ NO
Is parcel on private well or p blfc�
If private well, provide Hea epart ent form.
Zoning review can not beg n until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or i er
❑ YES U/NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # r
❑ YES ❑ NO
Will there be a 1w construction or renovations?
If so, obtair' e per Permit.
Permit #
Zoninu Tech to complete the following:
Reviewer to complete the followin
i W9b
Square
of Use:
Er YES ❑ NO p
Permitted as: =iA� 4o b f
Under Section:
Supplementary re ulations section:
Parking formu��A
Required spaces:
❑ YES ❑ NO (O
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations: I Pro rs:
❑ YES 2/NO Zr YES ❑ NO
If so, List: If so is p2�6 3�(•e
Variance: SP's:
❑ YES NO ❑ YES NO
If so, List: If so, List:
5/1/06 Page 3 of 3