HomeMy WebLinkAboutCLE200800124 Legacy Document 2013-01-17COMMUNITY DEVELOPMENTI Fax 4349724128 May 27 2008 02;05pm P003/004
Application for Zoning Clearance
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Parcel Owner.
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Parcel Address: City
(Welulde suite or floor)
PRIMARY CONTACT
Who this
should we call/write concerning projeCt7
Address:[ 1 (a of*n 14d 1'9:LV7 stain V
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Office Phone: Cello#131-040 Fax
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APP EICANT INFORMATION
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Business Name/Type: +e- _A7i�kiess a fr ryls
Previous Business on this site +Y7 ess I e'
Desexibe the proposed business inclading use, number of employfe7;p be'r of shifts, available parking
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vehicle additional informafjo that yon ide. 1Q_izL I IP 11
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*Phis Clearance will only be on the parcel ibr which it is app ved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby cel,'�ify that I o rhave the owner's permission to use the spaceindjcated on dais application. I also ceTt�fy that the information provided
is true and accurat - to t of m3, knowledge. I have read the conditions of apps X understand them a d tlig I will abide by them,
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Signature 0- Printed
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Co-ajityofAlbem:arlel)epartmexoktof Community DevelDpmeut
401 McIntire Road Charlottesville, VA 22902 Voice., (434) 296-5832 Fax: (414) 972-4126 -
Revised 04/28/08 Page 2 of 3
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COMMUNITY DEVELOPMENTI Fax 4349724128 May 27 2008 02 ;05pm P004/004
Intake to complete the following:
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Is use41 I,I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
` "N
XlWWilj�g e be food prepaz•atiori?
If so, give applicant a Health Department form.
,Zoning review can not begin until we reoeivc approval from Health
Dept_ FAX pAT)E
Circle the one that applies
Is parcel on private well or uc te x?
If private well, provide Hea] nt form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that appl'
Is parcel on septic or blic sew ?
Y l
WilI be putting up a new sign of any kind? If so, obtain.proper
Sign penxi t.
Perm it #
X
Wile be any new construction or renovations?
If so, obtain the proper Pernnit.
Permit #
Zoning to complete the following.-
Reviewer to complete the following:
Square footage of Use: "36 b
N p I
fitted as; P Gt�t
Under Section: —aAk. o� • o'
Supplementary xeg ations section
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Parking foxtpul .� O Q V•2-�
11 a.l
Required spaces: 8
Y/N
Items io be veri ed in the field:
Inspector
Notes:
Date:
Vlolati its:
x/ 11N
ifs , ist:
Proff s:
x/
If so, tst;
X/
If no, tst:
if/
If so, tst:
Cleara ce :
SDP'
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Revised 01128108 Page 3 of 3