HomeMy WebLinkAboutCLE200800092 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
511106 Page 2 of 3
OFFICE USE ONLY (,�py"�
❑ Zoning Clearance = $35
CLE # i�L.t10'
Check # Date: -,
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner.M uJ,'K i 0-g, 90Qea±1Q6 ILUc,
Parcel Address: '' 1�0 700) 31, City �,�/ +/ `- °�1`�011GState 'Vey Zilr�o' 6�
v (include suite- or floo
PRIMARY CONTACTy.
650l &Ala—
Who should we call/write concerning this project? ZI)0 �n � �I
Address : d o�A_1 py.p _ City Q 1 �L' —State (%c,-, Zipogoo
Office Phone: t( �34,) 4,01 - a-�.1/.�j Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: Ma
Previous Business on this site F-CJ_ L-6 �-1 i o- t Y- .S+
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature Printed Sczn b 6� 1 &21e�
APPROVAL INFORMATION
[PI Approved as proposed [ ] Approved with conditions ] Domed
[ ] Backflow prevention device and /or current test data needed for this site. Contact AC 3A, Ri ilil wi Mvice and /or
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a de n' iW Bl&TaC$ttUa4aNNW, (&is ing
site plan. Contact ACSA 977 -4511, x 119
[ ] This site complies with the site plan as of this date.
Notes:
Building Official c° Date, f
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
511106 Page 2 of 3
Intake to complete the following:
❑ YES LINO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES mINO
Will there be V 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 ❑4NO
Is parcel on private well or lic water?
If private well, provide He�lth e tnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES , AII0
Is parcel o ise tier ic�ewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 11
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain thAroper Permit.
Permit #
Zoning Tech/to comDlete the following:
Violations:
❑ YES
If so, List:
v❑ NO
n
A r
�X
IlN(
Variance:
❑ YES
If so, List:
NO
Reviewer to complete the following:
Square footage of Use: I
42 /YES El N Al r
Permitted as:
Under Section:
Supplementary regulati ns section:
Parking formula:
Required spaces:
❑ YES ❑ NO l� Cl��►
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
❑ YES v�NO
If so, List:
SP' .
PYES ❑ NO
sfo, List:
X
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