HomeMy WebLinkAboutCLE200800154 Legacy Document 2013-01-28Parcel Owner: L,:U . t U PTV YjO4---'
Parcel Addressl 5 7 &haJJaz 81tJ City V State V/ /
Zip Z Z-
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? clq, A16MI-1:7—
Address /, �i,� i��0./I city -QJ State k" Zip
Office Phone: Cell # 5,3! —DEG? 7 Fax #37-3 —270 E -mail G
I APPLICANT INFORMATION I
Business Name /Type: 4�Z , "
Previous Business on this site
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:
*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 hue and accurate t the best of�my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature U&W . /�CJ uw— Printed Vl ay 6 6��A
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determinal
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
tJ J. r, X 117.
nt of compliance with the existit
Duiiaing vinciai li� c .�•.. wage I,,-- Q
Zoning Official Date
i
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/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /NO
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 ;a:l:er? If private well, provide Healt epan form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer.
Y /0N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /N0
Will there be any new construction or renovations?
If so, obtain e roe erg, A
Permit # p�
Zoning to complete the following:
Reviewer to complete thj�e �fo lowin
Square footage of Use: I V
/N I.
ermitted as: 6 Oir
Under Section: PArX-R (-fl t19�V � r
Supplementary rego ions section:
Parkijng mint;
4;J (� (�
Required spaces:
Y/N d'
Items to be verified in the field:
r2M U" OYZ &44
Inspector : Date:
Notes:
Violations:
Y/N
If so List:
ffers:
Y N
so Lis
P L4 SP
Variance:
Y/N
If so, List:
SP
Y
If
s:
N
st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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