HomeMy WebLinkAboutCLE200800091 Legacy Document 2013-01-11Application for
Zoning Clearance
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Clearance = $35
OFFICE USE ONLY
CLE # 7-009
oning
PLEASE REVIEW ALL 3 SHEETS
Check# S03y Date: -0
Receipt # -7 13 Staff: CA
PARCEL INFORMATION
Tax Map and Parcel: 0'7 b o o bo o o o o P� Existing Zoning `d f
Parcel Owner: l�� �n 'T '�� _ �J zQ e't' cS S C'
Parcel Address: City %(+ 1u, State _V C1 ZipZ
(include suite or fl or)
PRIMARY CONTACT
Who should we call/write concerning this project? dQ
Address : q (ice j t "..4'y�i) �9,L, City ck( State LCL Zip 2-z-q
Office Phone: 'lam L 16 )Cell # 51.0-5"71-L Fax # E -mail
APPLICANT INFORMATION
Business Name /Type:
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: 'Sd f t
s
*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 the best of m/y� knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature """ I�- Printed a l-y c-c ",
APPROVAL INFORMATION
[ ] Approved as proposed VrAApproved with conditions [ ] Denied
[ ] Backflow 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 site plan as of t is date.
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Notes: L�� E CGU- COltid� 6yt� •
Building Official Date R
�(' Date / 0
Zoning Official 6P
Other Official 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 3
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Intake to complete the following:
❑ YES 0' NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 5R--N-O
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on private well or public Lq er9
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sew � L— --
❑ 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 complete the following:
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
Date:
5/1/06 Page 3 of