HomeMy WebLinkAboutCLE200800156 Legacy Document 2013-01-28Application for Zoning Clearance =�;8��
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PARCEL INFORMATIOJN ^
Tax Map and Parcel: (Q A.V !� � Existing Zoning
Parcel Owner:— z_ E' /' t 6.SevG F
Parcel Address: ydfdU i G ..�.f,G l y aa&ffeSt1 dI State V A Zi 'a 6
or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Pawcy Bf
a
Address : 14?) Teen) St nezr, -h State V/4- ZiPVL0V
S109 V$ 5_1V
Office Phone: (51h 3 1 #Q 0.00q Fax #35U— — VS0 E -mail 45 a�pl
APPLICANT INFORMATION
Business Name /Type:
*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 pennission 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 G'1 Printed-
AP,fROVAL,INFORMATION
Approved as proposed [ ]. Approved with conditi<
No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
ite plan.
] This site complies with the site plan as of this date.
Notes:
Building Official
Date
Zoning Official
Date
g
6g
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:
Is Oin LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wi 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 p blic wat r?
If private well, provide Heal Depa ent form.
Zoning review can not begin tun i we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic sewe ?
Y /
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y Ore Will / be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmnlete the fnllnwing:
Reviewer to complete the following:
IZOD
footage of Use:
V/N
Permitted as: /M
Under Section: PV- ' I
Supplementary regulation��t� n:
Parking formula: 4e®
b
Required spaces: 7
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Vv> lations:
/N
so, i t '1�/ pti r
d� Vy 1� �, �
offers:
Y/N
so, t: ��gi I (�
-V- o-
1114 4PQ
'1
Vari ce:
Ifs st:
SP's:
Ifs st:
Cle ances:
SDP's
Revised 04/28/08 Page 3 of 3
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