HomeMy WebLinkAboutCLE200800155 Legacy Document 2013-01-28COMMUNITY DEVELOPMENTI Fax 4349724126 , y Jul 18 2008 11:50am P003/004 j
Application for Zoninu. Clearance � ?�
CLR # 2006
PARCEL ZNFORNIA.T O —00 ev
Tai Map and Parcel: a�� � I 'Existing Zoning
l yr �`�f U'�'�A ►�"`
Parcel Owner: p J £q,
Farrel Address:
ess: City �Y I/ VJ Zip �� a
(include suite or floor)
PIZLVLARY CONTACT
Who s1tould we call/write conCerniug tlai tojec ?
1. Address: t "state -Zip
Office Phone: � � o �.. ✓'�` Cell # Fax � E-mail
Business Name/Type:
Previous Business on tins site
Describe the proposed business including use, ,number of
slovees, dumber of
of
*This Clearance will only be valid on the parcel for which it is approved. If you cbange, intensify or move the use to a flew locatim a now Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the spacciadicated ou this application. I also certify that the izrf'onnation provided
is true and accurate to The best of m of iedg! f!! d the conditions of approval, and I understand them, and that I will abide by them,
S(gnattue Ptin'ted; �
S.�
County of Albemarle Department of Community Development
401 McIntire goad CharIottesvllle, VA, 22902•V•oiee: (434) 296 -5832 Fax.: (434) 972 -4126
Revised 04/28/08 Page 2 of
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COMMUNITY DEVELOPMENTI Fax 4249724126 Jul 18 2008 11:51am P004/004
intake to complete the following:
is //,k�
ZS lu Z Z, HI or PDIP zoning? If so, give applicant a Certified
lrngineer's Report (CER) packet.
X
Wi ere be food preparation?
If so, give applicant a Health Depart rent 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 ter?
Zf pzivate well, provide Healt pempr�tlnierrt form.
Zoning review can not begin until we receive approval izoin Health
Dept. FAX DA T)
Circle the one that applies
Is parcel on septle o nubile er?
X
Wy u be putting up a new sign of any kind? if so, obtain proper
Sign pern-At.
FerwAt #
X/N
Will there be any new construction or renovations?
If so, obtaialxe proper Permit.
Verwit #R //,
Reviewer to complete the following:
1
Square footage of Use:
X
Under Section:
Supplemcntaxy reg4ations section:
Farldng fottnula:
Required spaces:
XIN
Iternoo be v W in the field.:
irtsliectax : L
Notes:
Date:
X/N
If so, List-,
Prof'
y (
If so,'Dist:
Va e:
X�
If zst:
SP`s•
if /
If so, ist:
ICleara;uce$:
SDF'.s
Revised 04/28/08 Page 3 of 3