HomeMy WebLinkAboutCLE200800176 Legacy Document 2013-02-19Application for Zonin Clearance
CLE #
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PARCEL INFORMATION
Tax Map and Parcel: �' o(� Existing Zonin
Parcel Owner:
Parcel Address:- .� ez City State Zip
(include suite or floor)
PRIMARY CONTACT •--� -� /' � p ,� �,/
Who should we call /write concerning this project? ! %✓I'CJ! ����5
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Address: V'� ` ffl :h UO�An 3dt' 7l- City f m State T Zip i o"
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Office Phone: (k�� IZI i�I Cell # Fax #� IOU, ZI -- d -mail -
APPLICANT INFORMATION
eg g aha apple: Cli -ang ofo ship hango Change of nam eh�tisin s
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Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, n mber of shift?, availabJe ar in spaces, nu ber of
�aYQ/
ve��ii,i,c es and any additional information that you c n 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 th best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature _ e ���2 /fifes
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] acktlow �e en to e�ice an o c�urr, n test ata Bede for is�site•. Co tae CAS 977., 45�1�1���1�9 ��'� ��'^���'��
o_P, h: l;ical�site ins "e�tto � � Abee done foz�this�cleat'anc i notyna determmation�of�comk?Pfiance w�th�the extstmg�
�: , .,,Wherefore .is
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sttecompltes tth the stye plan asof thts date?
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Zoning;OfficialA H i�r.F��Dat �% L },
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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
0
Intake to complete the following:
Y N
e MOM or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. t V �a ;,i e,
/ N> y
Y �
Wil tl ire 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 a ies
Is parcel on rivate wel r public water?
If private well ► e Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parce on sep ' • r public sewer?
Y
W' 1 //I ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
WilLdere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use: .L
Ae/ N
rmitted as: �ccn �/ � J ws r' A ►5GI"
Under Section: ,r 4A tai ► C Z
Supplementary regulations section:
Parking formula:
Required spaces:__________---
Y /�
Item�be verified in the field:
Inspector • Date:
Notes:
Violations:
Y
If os ist:
Proffers:
Y / rL
If so,st:
Variance:
Y /(11
If s6- T%t:
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3