HomeMy WebLinkAboutCLE200800096 Legacy Document 2013-01-11Application for
Zoning Clearance
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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OFFICE USE ONLY
❑ Zoning Clearance = $35
o r
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: (Yo 110 - V3 -a)'' O O Existing Zoning PUT)
Parcel Owner: rp Ra Ae,
ow�,,
Parcel Address: � .� 0 I � ► d� City State Zip
(incl'hde suite or floor)
PRIMARY CONTACT ,-
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Who should we call /write concerning this project? � V'le- 0z L\ )e rctl -P—
Address : c I- L) City ��- U W (. I e State V G� Zip z lo
Office Phone: 3 ` Cell # Fax # E -mail
P)ea6e 0 "(*
APPLICANT INFORMATION I
Business Name /Type: 5ic A- O�—
-
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:
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+1
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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 permission 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, and that Iwill abide by them.
Signature Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved 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 this date.
Notes:
Building Officia Date \k—
_
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 WNO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
[:]YES C. 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
n/YES ❑ NO
Is parcel on private well oNgo lic Ovate �
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
[21YES ❑ NO
Is parcel on sep is oiul�]L� sew
YES I,NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 14/1
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to comDlete the following:
Reviewer to complete the following:
Square footage of Use: ✓ ��
P YES ❑ NO
Permitted as:
Under Section: A /ors ;v � �V"
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES NO
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations:
❑ YES NO
If so, List.
Proffers:
❑ YES ,❑ NO
If so, List:
Variance:
❑ YES )Z NO
If so, List:
SP'
YES ❑ NO
If so, List: 49 q 0 — L,s
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