HomeMy WebLinkAboutCLE200800182 Legacy Document 2013-02-19}
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Parcel Owner:
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city Address: (
_ State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
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itAddress : y Q/L O7Z� !/ Zip /Zs�if
Office Phone: &3 i) � Cell # Fax #9V �! " ?3 0 2—E -mail o �1 y e /C r�V, 0'e
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Office 7, 79rAO Cc rh
I APPLICANT INFORMATION I
Business Name/Type: �i T%Q,�VA/%� ��,�loQ s 41,5f-
Previous
Business on this site /1 Tw (/ QA r" e
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any addif onal information that you can provide: SlJd t Ze iGA �rd9 ��� /'�.eIra
L>A%rJlaVees �' ✓ UII Tr ire
*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 est of my kn roledge, I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 46 ®d
an
County of Albemarle Department of Uommun►ty lieve►opment
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:
Y%N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 o pub is water?
If private well, provide Heat apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
W' N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # &2P1 Q° s 01300
Zoning to comnlete the following:
Reviewer to complete the following:
Square footage of Use: "/ -7 U iJ
/N
ermittedas: P— cr�4,I /_``I dc.5
Under Section:
Supplementary regulations section:
Parking formula: `7� u{�{ 37eO
Required spaces: 3-7
YIN
Ite o be verified in the field:
Inspector :
Notes:
Date:
Violations:
&/N
If so, List: h `
-72
Proffers:
Y/
If so, t:
Variance:
Y/No
If so, List:
SP's:
UN
If so, List:
93
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3