HomeMy WebLinkAboutCLE200800224 Legacy Document 2013-03-18Application for Zoning Clearance
CLE # ,?00 8-
Zoning Clearance = $35
OFFICE Ur ONLY r
Check # / (.,,- 3 �O Date: r b ✓��"�
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: c . 1 s Ll,
PARCEL INFORMATIO
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Tax Map and Parcel: — -2- Existing Zoning
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A 5,5o(
Parcel Owner: .
Parcel Address: 1 J ( Uo a J •F City 1 � l) �� I � State Zip aD Q
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: City C t U. 1 1 !'-_.. State J A--- zip) )9
Office Phone: Cell # J� �� S U Fax # E -mail lid yt (�8l
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: j (`�hi� �� K� k�(_CT)il)Jl ,��
Previous Business on this site `AA S Q, t/-pnr' t'`Cc
Describe the proposed business including use, number of employee l, number of shifts available . arki g spaces, number of
w� f � �� — /�
vehicles, and any additional information that you can provide: S j Lt 16
*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 pe 'ssion to use the space indicated on this application. I also certify that the information provided
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is true and accurate to the best of my knowled . I have read the conditions of approval, and I understand them, and tl Ilwill abide by them.
Signature Printed Z Oi/e 04- ' (�-(��1
APPRbYA INFORMATION
KApproved 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:
Building Official Date l� l i
/`T�
Zoning Official Date'�D�
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
I
Intake to complete the following:
Y/ lD
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi l re 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 wel or public
If private well, provide 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 septic o ublic sewer
/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign pe=t..
Permit # i Is 2—tvr! o 3
Y /1`th'
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmrilete the fnllnwinu:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3