HomeMy WebLinkAboutCLE200800117 Legacy Document 2013-01-16Application for "
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Zoning Clearance
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6oning
OFFICE USE ONLY �-
CLE # 20 063 — jl I
Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Check # 1 Date: :5 • � G
Receipt # 70i> Staff: of
PARCEL INFORMATION
Tax Map and Parcel: � (� � v , 1 M Ce Existing Zoninl gl,> f
(l p
Parcel Owner: St, S ckoa)
Parcel Address: 2 � JZ �y 1 � � . City ChC fl1AeW1 )1 State V 1 Zip �3
(include suitd or floor)
PRIMARY CONTACT
Ma
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Who should wecall /write concerning this project? R(D bj y
Address i((b ±-1iO State V A Zip 20-ID3
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Office Phone: �-) '�>ei Cell# i��'�U 7J �I��Fax #�( �-���j E -mail YroNu�fYl.YY1CtUl��4i';yab,
nmss -or-
APPLICANT INFORMATION
(Glt'YGSi S �c6 6� 1 ( 1' yi- pyc-Af oY4 aniza+100
Business Name/Type: �,J ft` ex) i J 3 )
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: p) �x Sf'P- ��i{7C�1yYtYVI�
*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 I will abide by them.
Signature VDAi� I V lX-UQA Le �1 Printed R 06 \J n MCA Vt)'l t' -J
APPROVAL INFORMATION
[proved
[ ] Approved as proposed 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 a of this e.
Noe .
aealw cowry 1 V4, 0
Building Official Date
Zoning Official 19 Date 6, 8
Other Official ^ GIG Date�G4C
GLG�r/
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/l/06 Page 2 of
Intake to complete the following:
Y/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will sere 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
Circle the one t at applies
Is parcel on pri ate well or public water?
If private well, rovide Health Department form.
Zoning review qan not begin until we receive approval from Health
Dept. FAX D TE
Circle the one t at applies
Is parcel on sep is or public sewer?
Y/N
Will you be pu ing up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be at y new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: —M+ !Y 1�- `
12 er N
ermitted a
Ur✓ider Section:
Supplementary regulations section:
Parking formulC"I
Required spaces: l�
Y/N
Items to be verified in the field:
Inspector : Date:
a1 V
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3