HomeMy WebLinkAboutCLE200800144 Legacy Document 2013-01-17Application for Zoning Clearance is CLE # & 00 2 --- I `'7' q
PARCEL INFORMATION
PRIMARY CONTACT rr II
Who should we call/write concerning this project? ,,.]'V'U';S
Address : 661 am- C+, City 11"A'Ay. - -s\ \-01 State V k Zip .M51eZ(
Office Phone: U
APPLICANT
Business Name /Type:
Previous Business on this
Cell 5 , ` �%�� Fax #
J k -
Q
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: 71S"5
e,, 5� Sq- W'NA r
o.I��r� . �s n t
*This Clearance will only be valid on the parcel for which it is apprdded. If you change, intensify or movelthe use toga new l6cation, a net) 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
County of Albemarle Department of Community Development
Ol McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
1# Revised 04/28/08 Page 2 of 3
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Intake to complete the following:
Y N
Is in LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 oraublic water?
If private well, provide 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 septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit. / J C3
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: `o "
I ermitted as: (�" iC �T E•s Cl"�1 1 Ubl
Under Section: :tb . A , L
Supplementary regulatioryl section:
Parking formulS
Je'l
Required spaces: r
Y/N
Items to be verified in the field:
Inspector : I Date:
Notes:
Viol ns:
Y /j
If so, t:
Proff
Y /(NN'
If so;�ist:
Variance:
/L
IfYs st:
's: N
s/o, s •
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Clearances:
SDP's
'Revised 04/28/08 Page 3 of 3