HomeMy WebLinkAboutCLE200800103 ApplicationApplication for
Zoning Clearance
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❑ Zoning Clearance = $35
OFFICE USE ONLY& W�_
CLE #
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: OW N A)'M_ 0 1U Existing Zoning / f j G' 'Cr__ k � �j
Parcel Owner: �tq® lU C 69 L97A
Parcel Address: _5fbff6 1. City(,�/ f I I C, State Zip
(include suite or (floor) RI),
PRIMARY CONTACT
Who should we call /write concerning this project ?�/y �i
/
Address:[ � � /� [)(T e:5- �/ City �t ��r �'� State J9' Zip
Office Phone: L_) Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: Eukh yiwi 1 f!!
Previous Business on this site c SRO
Describe the pr, a usiness, including use, number of employees, u er of shifts, avai able arking sp c s and any
aodi�tion l ' form( iat you can provide: , i I
*Thus 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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my rowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature G Printed
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APPROVAL INFORMATION &C
[ ] 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 Official Date o
Zoning Official Date g
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
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Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES NO
Will there xCoc d preparation?
If so, give applicant a Health Department form.
Reviewer to complete the following:
Square footage of Use:
Under S
C ;*
Zoning review can not begin until we receive approval from Health Supplementary regul tions section:
Dept. FAX DATE AEW
. YES ❑ NO ��� �� Parking forma : 4
Is parcel on private well or pub/,partmen water? ( ` t1i a q
If private well provide Health f form . P ,P l
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE J�o
YES [I NO
parcel on septic o public sewer?
x
YES ❑ NO,
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit. � ���� s
Permit # 1
W YES ❑ NO
Will there be any new construction or
If so, obtain the proper Permit.
Perm , it # ``lTk)) e) —9 -9 A
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,Vv U 1'1�
Zoning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
ations?
U YES NO '
Items to be erified in the.field:
_/
Inspector :y�{�W�o k.tA Date:
,Notes: Yb yxtl [� $
M
V YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
V0
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