HomeMy WebLinkAboutCLE200800173 Legacy Document 2013-02-19Application for Zoning Clearance` "'`'
CLE # �'4{C;IN�P :�
PRIMARY CONTACT
Who should we call /write concerning this project ?pi�fe�wl �U i sin S
Address :1n Besb!gavit, City State Ya Zip X2.0411
Office Phone: ( -110n Cell # 531i-01 Fax #43dr M-110( E -mail $�igctSQOr+{10 3��COw�
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APPLICANT INFORMATION I I
Business Name/Type: 7-16e UPS 5+0(C. 33-AA
Previous Business on this site —Tk1e ups .. -6m 5 :a4l
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 true and accurate to the best of my knowle ge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 4 �. �6Lt r Printed �7�1�17�EN /. .1J� S
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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/D
Is use m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will re 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 we I -or ublic water9
If private well, provide ea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic� ublic sewer)
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permi . %
Permit # 15,4e,
Y
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N IPermitted as:
Under Section: 4Z -5..'L , I
Supplementary regulations section:
Parking formula:�
S t.,4je i �4 cjv
Required spaces:
Y/A
Items to be verified in the field:
Inspector : Date:
Notes:
- - - - - -- -- -
Violations:
1 ?f /N
y'
f so, List:
- -- - -- -
`
Proffers:
Y / -
If so, ist:
Variance:
Y / o _
If so, List:
SP's:
(9 / N
If so, List: /
T=
Clearances:
SDP's
6 f—Z9
Revised 04/28/08 Page 3 of 3