HomeMy WebLinkAboutCLE200800101 Legacy Document 2013-01-16Application for Zoning Clearance
CLE # 2,0 OZ &.1
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�ning Clearance = $35
OFFICE US� O Y
Check # Date: i
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PLEASE REVIEW ALL 3 SHEETS
Receipt # Sta'ff:
PARCEL INFORMATION fcll
Tag Map and Parcel: DO- C90- (,D ° 0 9,50 i�, Existing Zoning
Parcel Owner:
Parcel Address: X 51 %S ),�Loo,&,m U, City C. c,r1ALT9yWe_ State Ok Zip LZ7c>3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? LLIX ''fib l-Ovv. i L� cJ
Address : I�0 J City State U* Zip ZZ`)O'
Office Phone: C � Cell # `1 f1f ^ d (n Fag # E -mail G %r>M 4i eAv' � ) .
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: t e—
Previous Business on this site—'
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, 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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and a,�e te to the best of my knowledge. I have read the conditions of approval, and Ip understand them, and that I will abide by them.
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Signature 7 �v Printed 9c'\
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APPROVAL INFORMATION
,VfApproved 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 Official 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
Revised 04/28/08 Page 2 of 3
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Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
/N
ill 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
Reviewer to complete the following:
Square footage of Use:
'V/N
Permitted as: G LA�
;
Under Section: 9 i r a7 .
Supplementary rep ations section:
Circle the one that applies Parking fo
Is parcel on private well ub ' ater? .• 5 4- l e✓�(' .
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces: / J (:5 W ,\O� ^ g�
Dept. FAX DATE f
Y/N V
Circle the one that applies Items to be verified the field:
Is parcel on septic ubT sewer?
Y /N�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # Q M-) (P -3101 (1
Zoning to complete the following:
Inspector C+ Date:
Notes:
J
Violat' s:
Ifs ist:
Proffers:
If so,is .
V riauce.
Ifs ist:
Ifs i
SP's:
Y /
If so, List:
Clearances:
SDP's
Fla.
Revised 04/28/08 Page 3 of 3