HomeMy WebLinkAboutCLE200800216 Legacy Document 2013-01-03Application for Zoning Clearance
CLE # Z. 0 0'3 - Z-10
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2t/oning Clearance = $35
OFFICE USE ONLY
Check # iZ34 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7QJ7 J Staff:
PARCEL INFORMATIO
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Tax Map and Parcel: Existing Zoning
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Parcel Owtter: 1! 'V f -1pV e (i
Parcel Address:,, City t`,lf WWItCSVJb_ State ,}" Zip23A/ I
(include suite or floor) G� � � SC
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PRIMARY CONTACT
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Who shouldppwe call /write concerning this project?
Address: -Q&i;z, -1 \ PkU City 'h ( au State ► -\ Zip
St7 •�-� 2PC) 1, , _e6o
Office Phone: Ct tN ' V- ?7,xj Cell # ci f Fax # Y3� 7 E -mail { mv, ju,,LA_5 T(��4. C
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: �1 ��� l�^'�SC�c�� r�a1 ` �_ - � Sei � t `olQ o ttl
Previous Business on this site ! ^�
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: (10 tlA&p(no jeo 5
*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" est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ` I Printed �� r r,I Vk aV !t r 1�S
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.
[ J 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 j ITO r-
.Tl
Official �'I Date��1��
Zoning
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
Reviewer to complete the following:
Square footage of Use: Z
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
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-K
Yll
Permitted as:
'
Wil i ere be food preparation?
Under Section:
If so, give applicant a Health Department form.
's:
/ N
If so, List:
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well ora!1!1 water? ,
Clearances:
SDP's
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required- spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or�public sewers
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ^ I
Permit # / `f
Inspector : Date
Y / N
Notes: )
Will there be any new construction or renovations? p�
If so, obtain the proper Permit.
Permit # f� %
� qo--,
7,nnincr to emmnlPtP the fnllnwin4!
Violations:
Y /N
If s 4 ist:
P roffers:
If so, List:
Variance:
If /�N�
Ifs st:
's:
/ N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3