HomeMy WebLinkAboutCLE200800212 Legacy Document 2013-03-18Clearance
Application for Zoning
CLE # % L, , o? �J c�%
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OFFICE USE ONLY
❑ Zoning Clearance = $35
Check # / Date: 9 D
PLEASE REVIEW ALL 3 SHEETS
Receipt #7 Staff:
PARCEL INFORMATION A
`,^a 6 P L Existing Zoning
Tax Map and Parcel:
Parcel Owner: k )tjoer i- 45:,-0 ,C;JeS
Parcel Address: S7 .i ( --n, LCc, � 1, n p City State 1/ 4 Zip r);+C 0
(include suite or floor)
PRIMARY CONTACT II__
LP_
Who should we call/write concerning this project? CfZ `fin
Address : 37 J (pQr Lerd &-m J�) oA City C�Ar l OeSV+ 16 State 1/ Zip a�a�
Office Phone: Cell# 6)-i- a3a-3lii/Fax# 113y"g:?7J-7c�C�E -mail biC,(;6Gn Cony12C1.on5
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C ;roprr -dix ,cp
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Cedl ?r , LL C,
Previous Business on this site %IA
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
CkC0 [ �%LE?
vehicles, nd any additional information that you can provide: AM r,7 %C 0 f ° la 2220/Q v E.p. 5 ;
4,c c: �, ; mo 1/e�'Ae-,
*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 o ee emission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best o y o dge. I have read the conditions of approval, and I understand them, and that I will abide by them..
Signature Printed
APj!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
site plan:
[, ]'This site complies with the site plan as of this date.
Notes:
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Building Official Date ai �s
Zoning Official v Date 3 ��
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/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil 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 we r public wate
If private well, provide 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 or p is sewer?
Y j/ N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit F "'
# �7( 0 -(
YjN
ill there be any new construction or ran ations?
If so, obtain the proper Permit.
Permit # 6
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y// N
-Permitted as•
Under Section:
Supplementary regulation sAction:
Parking forn7ula. _
Required spaces:
Y/N
Items to be verified in the field:
Inspector Date:
Notes:
Viol ns:
Y
If so,: Est:
offers:
/N
so, List:
t
ov
Var' ce:
Y/N
If so ist:
's:
N
o, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3