HomeMy WebLinkAboutCLE200800151 Legacy Document 2013-01-28PRIMARY CONTACT
Who should we call /write concerning this project ?�- cJ��L -��
Address :35��� Zt3, City�;17<r1afi47; v'Lw State Zip V40 %
Office Phone: (3 )f-71 Cell # 6 -I ft Fax # 73 M E -mail Q
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INFORMATION
Business Name /Type: 14-o re ,W-A )
Previous Business on this site /t/ f 00 G- ' /V_e,0 CMS7 l CM
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: AID c� w.ri v� �,` c� F, -t Lt- M� nj2 } ew
*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 pernriss .op,n to use the space indicated on this application. I also certify that the information provided
is true and accurate to tthe best of my • owledge. Ufaveread the conditions of approval, and I understand them, and that I will abide by them.
Signature:L �_,'-'J(7, Printed t�ys✓ � N��{�*
AP ROVAL`INFORMATION
Approved as'proposed [']A pproved with conditions �" [ ] �De' nied -
] Backflow prevention device and /or current test data needed for this sife. Contact ACSA, 977-4511, x11.9:
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with tle'existing
sit p�an.
[VI This site complies with the site�plan as of this date. Q Imo,
Notes: 20 a t -' l l fcO N C. ✓Wt 0 l
lsunding 0iiiciai M
ua�e
Zoning Official
Date
Other Official
Date
County of Albemarle Department of Community Development
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 / POA4 C.
Is u e in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y //
Wil ere 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 Zblrc w er?
If private well, provide Health r ment 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 ublic sew r?
Y/N
Will you be putting up a new sign of any kind?
Sign permit. 7
Permit #
Reviewer to complete the following:
Square footage of Use: & l S 9
ermitted as: (4;&
Under Section: oI • 1
Supplementary regulat'os section:
Parking foTL[115�oo i��
Required spaces
Y/N
Items to be verified in the field:
If so, obtain proper -
Inspector : Date:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 7
Zoning to complete the followinLY:
i
Violggons:
Y �' ITV
If ,List:
P ffers:
N
so, List:
.Z AAA x-003- if
2 AAA 11 ti 6 — Y
Var' ce:
Y/6
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's � � 0 -7
/ w Revised 04/28/08 Page 3 of 3
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