HomeMy WebLinkAboutCLE200800047 Legacy Document 2013-01-03Application for
Zoning Clearance
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Zoning Clearance = $35
OFFICE USE ONLY
CLE # 200 9-
PLEASE REVIEW ALL 3 SHEETS
Check # ,3t Date: a
Receipt # (1_ Staff:
PARCEL INFORMATION
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Tax Map and Parcel: Existing Zoning
Parcel Owner: �J-2 �41`y\ A r e G f LC , L ' L
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Parcel Address- 11 L O , 4 ma r h r, 5}e, City cyogf �b cwil�{' State \/ Zip 22 6 1.
(include suite or floor)
PRIMARY CONTACT I - \ -�
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Who should we call /write concerning this project? G Yy1 G \Ul
Address : Sewn \, jo 4C • SI-e 2 6 2. City C ke f lo7-W) i Ile State Zip22°1
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Office Phone: (13w) �11� _1.7 t-2. Cell # � 3y_ 53/ -y� Fax #13`1 - %5- $SSE -mail S\)( -M S 1 ER CV �-_t
APPLICANT INFORMATION /
Business Name /Type: zp�A-T(A� S v -S(\C . Les►a -► rv) pr'C • l G/2 'I
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: C_6- ry-,j n e (c cx3 r !,P a m k V- "1 Qrn
SAC ,
*This Clearance will only be valid on the parcel for which it is approved. 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 accu ate to the best of ury knowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature ��� qzi� (� Printed ii ,n, 1' S n -EQr +_���
APPROVAL INFORMATION
[ f�pproved as proposed [ ] Approved with conditions BaCkf10W DeV[iCC Sj �e i k
[ ] Backflow prevention device and /or current test data needed for this site. Co taEWMMt)TTAt"#jtlyeeded
it is 9?7 4n3 41Li'cc� With the
s[�] No physical site inspection has been done for this clearance. Therefore, lCOt41tac$*(3SA existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date 1 a�
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McILrtire 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:
❑ YES
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES N NO
Will there be food preparation?
If so, give applicant a Healtb Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on private well o public wat r�
If private well, provide Healtb D artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO --
Is parcel on septic or public sewer?
__...
❑ YES &, NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to comDlete the following:
Reviewer to complete the following:
Square ootage of Use: % 02
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YES
Permitted as: MIt S i!/�0� c i V G2
Under Section: O�`►'� 6-0
Supplementary regu ations section:
Parking .%A a: rL&�'
� e � 1 4
Required spaces:
❑ YES ❑ NO
Items to be v rified in the field: /'.
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Inspector
Date:
Violations:
[I YES [B NO
If so, List:
Proffers:
❑ YES 0 NO
If so, List:
Variance:
❑ YES
If so, List:
j'
IZ NO
SP's: ,�..--
❑ YES PZNO
If so, List:
511106 Page 3 of 3