HomeMy WebLinkAboutCLE200800202 Legacy Document 2013-03-18N46ri "Pa vtv
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Application for Zon in Clearance
CLE # �-
V�RGIN�P
Zoning Clearance = $35
PLEAREVIEW ALL 3 SHEETS
OFFICE USE ON
Check # ✓, /PC/ Date: Z 1-6
Receipt # '7 Z v S— Staff:
PARCEL INFORMATION
Tax Map and Parcel: / z Existing Zoning'
Parcel Owner: MOND 6IJ06 C/ /
Parcel Addressj l �(J O /G (1 , (% City ,/ w State 1CT" Zip;Zt7O
(include suite or floor)
PRIMARY CONTACT --
Who should we call /write concerning this project? d_67C;1_1 r -
Address :�y_V k65e_i1,777;�r1,e,1 City ilyf x'104 %i° m State Zip 0
Office Phone: (Cell # -� Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business'
Business Name /Type:
Previous Business on this site
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 ha e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate t bes o my kno�yl dge. I have read the conditions of approval, aA I understand them, and that I will abide by them.
Signature Printed
AP ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
sKeihan .
ts site complies with the site plan as of this date.
:
Buildi ng Official Date �—�
Zoning Official Date org
Other Official Date
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
2d
Intake to complete the following:
Y /VIs u in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Wil Y'fFi 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 ublic wat
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap 1'
Is parcel on sep • or public sewer?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /
/ Nl�
Wil re be any new construction or renovations?
If so, obtain the proper Pe t.
Permit # —W7,4c, it
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: _ tv, I /
'Permitted as: 4e 4A
Under Section: au, a,
Supplementary regulation section:
711A
Parking formula•
Required spaces14(,0 /f ` Y/- . /
Itlxs to be verified in the field:
Inspector : Date:
N&,� 1`' 4" A c O p I �C-
V1014-ions:
Y /
If so, ist:
:
FRIList: :
V ar•�a'nce:
Y/U
If so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's Q60 q y
Revi d 04/28/08 Page 3 of 3