HomeMy WebLinkAboutCLE200800094 Legacy Document 2013-01-11Application for
Zoning Clearance
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❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # Q Obf - c
Check # Ido Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7D `VA-3 Stath
PARCEL INFORMATION
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Tax Map and Parcel: '/ Existing Zoning
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Parcel Owner: ,7( dt,E (_
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Parcel Address: _Q-V /J Fa * -6e-is i � a cl City C%crr (JeSU& State v114- Zip Zz�v j
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ✓6�i/—iG /� �Cc ��_°J�: e��
Address: =a415- Cr4,_ _ City 61,&(- fo 9--SJA1(k State f zip z
Office Phone: `l(3 a' %3 -5P� 0I Cell # Fax # &30Zf3 6T 141 E -mail �/,Au ik(ii -ak <2411-:ire U rd
APPLICANT INFORMATION
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Business Name /Type: S tems e- ��-LIf
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: %2,ti S air (CIx+P-[ f 2.6 q( , ZO dd
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew 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 best of my knowledge. I have read the conditions of approval, and understand them, and that Iwill abide by them.
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Signature 0�� Printed /64 Acl 7Ter�e
APPROVAL INFORMATION
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[ ] Approved as proposed [Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current of st 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 this date.
Notes:
Building Official �^ Date L(
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
Intake to complete the following:
E �S ❑ NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
BYES ❑ NO
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 ��Q� %� ��� Aj
❑ YES �privrate
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Is parcel or public wate r?
If private w, Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE deyf A /'D -M3
❑ YES [Z NO
Is parcel on septic or public sewer?
❑ YES >fl NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES NO
Will there bef any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 'Tech to complete the lollowing:
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 fonnula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector
Notes:
Date:
5/1/06 Page 3 of