HomeMy WebLinkAboutCLE200800153 Legacy Document 2013-01-28Application for Zon'ng_ Clearance��
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CLE #
Zoning Clearance = $35
OFFICE USE ONLY 7�2
kcle'�" 4 Dater l�
PLEASE REVIEW ALL `3 SHEETS
Receipt# 1-/ Staff: cl.
PARCEL INFORMATION
Tax Map and Parcel: Existi ZoningLJ tf
Owner: fsa
Parcel dy-sr ' 1
Parcel Address: lc000 P,ln PoH-l7 CityCNg.(?i l2nt=SVI State YA Zip 22.qU)
(include suite or floor)
PRIMARY CONTACT
Cc)
Who should we call/write concerning this project? ' i-,c dA 1 � �-e ` )7LroI� n
Address :) Coco E0.S-I- e—IU `i -oc, 'I city C hadc" .�_ Wlt `State VA Zip ja
Office Phone: (1 I) q-j .CjS Cell #Q } -C139 6 ax #,VA91Qn1�%5E -mail _kffi? jL rc�1'Y Sia�ric
APPLICANT INFORMATION
Check any that apply: Change of ownership . ./Change of use Change of name New business
Business Name /Type: -JRE-r.4s,, t t_ SH 3pPl9VC7- rAA-L.L.
Previous Business on this site `� �A t l_ ShkOPPI t`!G— YY1PtL��
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: U45 re-Fft; ) � �P_S (i* ,r, �_i� P )— / `R 9n9
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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 ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signa Printed Frim n— , 1 {- {---iP �
APPROVAL INFORMATION
[ ] Approved as'proposed [ ] Approved with conditions �/ Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119./
[ j No physical site inspection has been done for this clearance. Therefore, it is not a determination of compl c with the existing
site plan.
[ ] This site comp ies wit4 the site plan as of plan as
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Notes; _ —
,
Building Official Date
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give
Engineer's Report (CER) packet.
Y/N
Will there be food preparation?
Reviewer to complete the ollowing:
Square footage of Use:
a Certified
Y/
Pe d as:
Under Section:
If so, g e applicant a Health Departme , t form.
Zoning re iew can not begin until we receive approval from Health Supplementary regulations section:
Dept. F i?ATE
Circle the one th`�t applies Parking formula:
Is parcel on priva well or py lic water?
If private well, prove �e Health Department form.
Zoning review can not egiA until we receive approval from Health Required spaces:
Dent- FAX DATE
Circle the one that ap .'lies
Is parcel on /septic public se er? Y/N
Will you be p a new sign o ny kind? If so, obtain proper
Sign permit
Permit #
Y/N
Vere be any new construction or
obtain the proper Permit.
it #
ZoninLY to complete the followinLy:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, t,
'N" offers:
YN
If so, L\
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: /
\
SDP's
\
Revised 04/28/08 Page 3 of 3