HomeMy WebLinkAboutCLE200800139 Legacy Document 2013-01-17Application f ®r Z® ing Clearance
CLE #
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PRIMARY CONTACT
Who should we call /write concerning this project? K, , 1 1,,,._c-»VAJe'-
Address : 1'I0 u xl City State Zip 722ck Lk
Office Phone: ; cf Z yS -C) 'Q i Cell # cl�;'L' S 1�;� Fax # E -mail kit,., e�esieY6?
APPLICANT INFORMATION I
Business Name/Type: ;C.��Aow-n lNtl-k Joz�n o-EI ? o lu
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking on? .n spaces, "number of
vehicles, and any additional information that you can provide: i� c g 1, .„.�,�� e� s, se
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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 I will abide by them.
Signature Printed k "tti, i -'—
site plan
4,
[ ] Tlus sttezcomphes with the site plan as of this date;
•Notes.
Building Official
Date
P
i `� 1 1
Official
Date
Zonin g
Qther Official
Date`
County of Albemarle Department of Community Levetopment
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/
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/e)
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
Circle the one that applies
Is parcel on private well or ublic water.
If private well, provide Health -e� ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or (public sewe ?
Y/N '7
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # warr;o�i�
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ! "6
7nnin¢ to complete the following:
Reviewer to complete the following:
Square footage of Use: 2 S `3 SF
Yom/ N rr
Permitted as: � F�('O oq(ce,
Under Section: % i , ? , l o-D
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Date:
Notes:
CfA6 i 1 dtinki ( -7 117/2 -d 10
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