HomeMy WebLinkAboutCLE200800211 Legacy Document 2013-03-18Application for Zoning learance
CLE # Q da d 01qT(
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❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # 1 Date: ,Z!5 6
PLEASE REVIEW ALL 3 SHEETS
Receipt # ° Staff:
PARCEL INFORMATION n C
Tax Map and Parcel: '�2,C c'7 °��J,b ^DO —��S +T® Existing Zoning G
Parcel Owner: L—ac- k L4,
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Parcel Address:T�D�'y(,lo)o` i Dr•, City(/�U�, - k, 111(e. State Zip 2 f�
(include suite or floor) a
PRIMARY CONTACT
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Who should we call /write concerning this project? I (31j C+[1t) Vj
Address :� �-L-)a L `v oo City C q S V L �—State VA Zip -fit f
Office Phone: 1 -74 -7 Cell # G%q6 7 yf33 Fax #�1 �t f '� �� E -mail ��Xr"'�'��yy�y '
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Pj crl c`7
Previous Business on this site Vet.CG� n
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: %L �� Q
*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 infonnation provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ° G', Printed e:4 f-- -' -k tr—tb V-�,
APPROVAL INFORMATION
[ L] Approved as proposed [ `] Approved with conditions [ ] Denied
[/ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
Gj]'No physical site inspection has been done for this clearance. Therefore, it is not adetermination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date 1
Zoning Official Date
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
Intake to complete the following:
Y/(9
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Willoere 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 public Dwater
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic o,
Y 1` '
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /1'tlf
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonings to complete the followings:
Reviewer to complete the following:
footage of Use: `J'' o LA
Rermitted as:
Under Section: �' a - `
Supplementary reg lations section:
In I
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ons:
Y /�
If so, ist:
Prof
Y(
Ifs , ist:
Var e:
Y /
If so, List:
SP's:
Y�
If , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3