HomeMy WebLinkAboutCLE200800044 Legacy Document 2013-01-03Application for
Zoning Clearance
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❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # ° i= e aC96 'R060' _
Check # '/ Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # �%S �— Staff: ti-13r
PARCEL INFORMATION
Tax Map and Parcel: -- I O�� lT Existing Zoning �4 L—»
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Parcel Owner: r,
Parcel Addressj -7jC 17,nele T7,,' `(�e� City` %1iI /LCr State (/ Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project9 i r�tii /�� j'J z—, 2 4, /
Address:/Q& P 1/ City State t4& Zip
Office Phone: L Cell # .5 3l %'P-Fax Pj jY/LYY" YN mail
APPLICANT INFORMATION
Business Name /Type: -7 !z�z 2.0 m e 4al L 37
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eZ
Previous Business on this site-72
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
addition 1 information that you can provide: 1=4 -44 `Z P_.- -(a61 cc e, : c % r
/ion
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/'crt le ®ter,• �; :, R .
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*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 to the best of r knowled e. I have read the conditions of approval, and I understand them, and th t Iwill abide by them.
, /
Signature Printed C
A,i'ROVAL INFORMATION
[ ] Approved as proposed [ ]Approved with conditions i
I 'l eviee and /or
[�] Bacl&ow prevention device and /or current test data needed for this site. Contact ACS , 9� ,
/No physical site inspection has been done for this clearance. Therefore, it is not a det ni� ?Kii 6i� iii t'iPiied wiNttbdedsti g
Yte plan. Contact ACSA 977 -4511, x 119
[ ] This site complies with the site plan as of this date. -
Notes:
Building Official Date
Zoning Official Date 2 b
Other Official �1� G(,t r� Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of
Intake to complete the following:
❑ YES V" NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
!/ YES ❑ NO
Will there be food preparation?
If so, give applicant a Health Del
If so, give applicant a Certified
form.
Zoning review can nob gi (until we receive approval from Health
Dept. FAX DATE 2D0 g�
❑ YES 0 NO
Is parcel on private well or lljj hlic a?
If private well, provide HealflrDe rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or tfse ler?
❑ YES NO
Will you be 4PL n g up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
❑ YES Ft-1/NO
Will there b any new construction or renovations?
If so, obtain the proper Permit.
Permit #
L onlnLx^l ecil to complete the tollowmQ:
Reviewer to complete the following:
Squa e footage of Use: i b �.C,i
;YES ❑ NO
Permitted as:
/ QQ
Under Section: � .1�•oz37
Supplementary re ulations section:
'N/ 0.
Parking formulae a' ( 3 /L 0
Required spaces: Y .
nC/ G
❑ YES ❑ NO
Items to be vaified in the fie d:
Inspector : I Date:
Notes:
Violations:
Er YES ❑ NO
If so, List: 1 6� / _� ��
Proffers:
❑ YES
If so, List:
FL-1-No
Variance:
If so, List:
/
L2 NO
SP's:
❑ YES
If so, List:
RI
NO
NO
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