HomeMy WebLinkAboutCLE201300018 Legacy Document 2013-02-15_ tl1
Application for Zoning �{/ 1 Clearance
CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 0A 5 Date;
Receipt# /O Staff;
PARCEL INFORMATION
U� aG �4 Zoning
Tax Map and Parcel; (/ Ming
Parcel Owner., C LS
Parcel Address: 4-1 L L. e "�S" t� City State VA— Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? r°' 2.u-4� v yo n
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`� a 4' M�gnollc}e� �,�, city N i State, V r`C Z1ip 23 U
Address :_i
fflce Phone: ( E-mall S�n� 7e
L�&PLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change of name New business
`.
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Business Name /Type.- t��
{•
Previous Business on this site
Describe the proposed business including use, number of employees nurr}ber of shifts, available parking spaces, number of
vehicles and any additional informat that you can provide; ** —g co" — i, tJ OVA-,
*This Clearance will only be valid on the parcel for which it is approved. Ifyou change, Intensify or move the use to a now 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 b of my knowledge, I have read the conditions of approval, and understand them, and that I will abide by them,
Signature Printedn�
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APPROVAL INFORMATION
>` Approved as proposed [ ] Approved with conditions [ J Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -451 l; x117.
[ )No physical site inspection has been done for this clearance, Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
N o tes:
Building Official Date jai
Zoning Official Date
{�
Other Official Date
• Countyof Albemarle Department of Community Development
401 McTntire Road Charlottesville, VA 22902 Voice; (434) 296 -5832 Fax.- (434) 972 -4126
Revised 7/112011 Page 2 of 3
VIM
Intake to complete the following:
Y / �i�t J
Is us n LI, HI or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0 ill N
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 app i
Is parcel on p
Iva a welt r public water?
If private well, ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the o e that ppiles
Is aN n eptic public sewer?
Y Wie p utting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / jN/ _
1�Yil • e be any new construction or renovations?
If so, obtain the erPerout.
Permit #_i
Inn — f., nnr "hh +a fhw fnllrnvino'!
Reviewer to complete the following;
Square footage of Use: , t/OoD
y , i,
Permitted as-, l___s�[ T" ✓� s�s ti's
Under Section: _ r�'� r'U,'Z • 1
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector ; Date:
�+'f�/I�LTP1 X71' ' 1» deL11/
Viol , tions:
If so, List:
Proffers:
If o`; List:
Varra e;
Y /aV
If so, List:
$P'si .
/N
If so, List: q
Sl 3�
Clen rances;
SDP's
Revised 7/1/2011 Pago 3 of 3
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