HomeMy WebLinkAboutCLE200800087 Legacy Document 2013-01-11Application for
Zoning Clearance
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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
OFFICE USE ONLY p �%�/
000
Zoning Clearance = $35
CLE # 6/ /
Check # s Date: -D
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 0 /9 A (� o _ U 9 - (J l Existing Zoning n,-1
Parcel Owner: `T&" /VI
ParcelAddressd(3-) i'a'-s-r K:�tCSC by,. City `CAfSLA_1\Gk State VA_ Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project?
Address :I t 3� � ( l�T W (Ct� Y City 165SW kU<- State �/ C� ` Zip
Office Phone: # 91x(1 Fax # E -mail
ell
APPLICANT INFO TION
Business Name /Type: .—Id R-e
N C) N 4--
Previous Business on this site
Describe the proposed business, including use, number em pl s, number of shifts, available parking spaces and any
additional information that you can provide:
*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 accura , edge. I have read the conditions of approvall, and I understand them, and that Iwill abide by them.
�ofiny
Signature Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Deni9d
[ ] Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 ite plan a . f this date.
Notes: !leg V9 /LI L rS D ms .
Building Official _ �� J�.�- +- -`--�_ Date
Zoning Official Date
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
Intake to complete the following:
❑ YES D11NO
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 e ii we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is parcel on privat we or public water?
If private well, provide Health Department form.
Zoning review can not l'in a �Itil we receive approval from Health
Dept. FAX DATE
EE YES C1 NO
Is parcel o septi or public sewer?
❑ YES ®,N O
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 complete the following:
Violations:
I—I VRQ I—I TTn
Reviewer to complete he following:
Square footage of Use: A(A
[(YES ❑ �O
Permitted as: o- Ili v1 Y
Under Section: to, � , t o
Supplementary regal fr section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes: 2 VvYwx CG�/C L� {r s U-A 6 1 GL
7
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
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