HomeMy WebLinkAboutCLE200800164 Legacy Document 2013-01-28Parcel Owner:
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Parcel Address: ('��( E►.t �{~ (��'. City l O C ate , �
ZipA
(include suite or floor) '
PRIMARY CONTACT
Who should we call /write concerning this project? An 4 P ice_, \g n vi
Address : j �,�_1 t / City Al '►" State Zip
Office Phone: lo ell # E 1 -Fax # E -mail
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APPLICANT INFORMATION
Business Name/Type: "T Ilk e. t,�P' r � �� f" / i�C'. ec�Ae a e PT—
Previous Business on this site j 07KI&A '-A )AA, r'
L—_AfK Q. / (0t v! I
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles,,and a7 additional information that you can provide: 0&, ;( ct- i:4er.rUCP
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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 the best of my lm . wledge. I hhavve r ad the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed r%Q
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 /,
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
V/ N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE'.
Circle the one that applies
Is parcel on private well or p b�lic w�a dr
If private well, provide Health 1 eeppartmenf 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 lic se er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnlPtP tha fnllawinu-
Reviewer to complete the following:
Square footage of Use: S
91N ,
Permitted as: r`xt r�
Under Section: '1 - a �l 1 ,-7
Supplementary regulat ns section:
Parkingfbj.MuLa:j
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If st:
Prof er
If :
Yplu
V aria ce:
Y
Ifs st:
/ Nr
so, List:.Qi'�
U �
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3