HomeMy WebLinkAboutCLE200800078 Legacy Document 2013-01-11� 1
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Application for
Zoning Clearance
❑ Zo ing Clearance = $35
OFFICE USE ONLY
CLE # -d,66 ?06(!�n
Check # 6& 5k Date:
PLEASE VIEW ALL 3 SHEETS
1
Receipt # 6 a 1;9 Staff. y
PARCEL IN O TION
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Tax Map and Parcel � V66 6 G p' �� ��y� Existing Zoning J- T�
Parcel Owner: ,,5WX4 -' /yI / 210AIR
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Parcel Address: l ek t S City �lc p.�/�Cv'/ /r�C/��Mate 14 Zip ZZ
(iAclude Suit or floor)
PRIMARY CONTACT �,`J �!
fir""!!
Who should we call /write concerning this project? lrf7�
Address:--3/,,9 t2��Ayo ' �l� l �� iCi / to Zip 1=' V
Office Phone: C f ell # lS Fax # �/i/`j2' E -mail &e/ mkli5_
APPLICANT INFORMATION i
Business Name /Type:`/ -^ / /drP1� -P /C P����►'��
s /
Previous Business on this site „Y�i✓(
Describe the proposed business, including us umber of employees, n��er of shifts, available parking spaces and any
add' Tonal information that you can provide:' e%YYJ
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, arid that Iwill abide by them.
Signature.iL� %��.��% Printed.
APPROVAL INFORMATION
proved as proposed [ ] Approved with conditions D �' ce
1 9. ���ce and/or
B�lcflow device /or data for Contact ACS 97451
] prevention and current test needed this site. , ., .a�cen eded .
[ Cilgo physical site inspection has been done for this clearance. Therefore, it is not a dote ii iI'$ o t w tale e n
site plan. Contact ACA 977 -51 T, x
lies wit �site la 1 as of th's d1 .
[ ] This site co tl
Notes: � (�
Building Official Date ot o
Zoning Official Date
Other Official (Nv ry ✓(/J ON 4� Date 6g
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 3
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Intake to 711ete the following:
YES O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YES F-1 NO
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not i n lints we receive approval from Health
Dept. FAX DATE d
K YES E] No
arcel on private well or (mblic wa er?
If private well, provide HeDe artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
s arcel on septic or p b�fy c s� ?
❑ YES [V NO �/
Will you be // utting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
❑ YES Any NO
Will there new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to comDlete the followine:
Reviewer to complete the following:
Square footage of Use:
YES ❑ NO L V
1De1•mitted as:
Under Section: g!5,� i} .
Supplementary regulations section:
/A F
Parking formula/_ _
pp'u
Required spaces:
❑ YES ❑ Nb d
Items to be verified in the field:
Inspector : Date:
Notes: l
Violations:
❑ YES ❑ N
If so, List:
Proffers:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
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