HomeMy WebLinkAboutCLE200800225 Legacy Document 2013-03-18Application for Clearance
Zoning
CLE # �L�
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Zoning Clearance _ $35:
OFFICE USE ONLY ZUci i ve
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Check # Date: /d -/ q O
PLEASE REVIEW ALL 3 SHEETS.
Receipt # — /" Staff:,(
PARCEL INFORMATION
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Tax Map and Parcel: 5"5,0 , Pwce r y� Existing Zoning P /co W/
Parcel Owner: J000e,/0f E, o -L.muc
Parcel Address:_ G/.y City 6`0 Z e_� State V Zip
(include suite or floor)
PRIMARY CONTACT J
Who /write 0 / �
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should we call concerning this project? M 6� c_
Address : 171y City en2 e�f State "u Zip 225/ Z
Office Phone: (Y7 q) ,3Z-f� Old' Cell # Fax #D7 , ??f -OTT E -mail OrCJ�G7WCA-�onSfrAOf:
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APPLICANT INFORMATION
Check any that apply:.' ". Change of ownership , "' Change of use nge Cha of name New business
Business Name/Type: ('C'Cevr,S`}Yfi�(�f, L LL — /fw�{ S'G,(fC�'s,, ,Qa,<•`i,•,Sl
Previous Business on this site w�2, G�hd�P -� 1,10M-e 0(_UAjaM1"r^
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:
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*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature .`'' Printed P701 (6W
APPROVAL INFORMATION
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[ ] Approved as�proposed " A ith.conditions . [ ] Denied
[ ] Backflow preventton,devtce and /or current est data nee ded..or�this stte[ Cootaet A "CSA, '977 - 4,511, x1.19.
[ ] No physical site inspection has been'done for this clearance. ' Therefore; tt is not a determination of compliance with the existing
site plan:
[ ] This site complies with'.the site plan as. of this date
Notes:
Building.Officiat``.`�
Zoning Official Dated /S,U
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: Reviewer to complete the following:
Y / (N) Square footage of Use: , -vJ
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
ermitted as:
Y/.
Will e be food preparation? Under Section:
If so, give applicant a Health Department form. �T
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
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 or public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Parking formula:
Required spaces:
Y /�Item e verified in the field:
Inspector:
Notes:
Date:
Viola ions:
Y /
If s , ist:
Pr off rs:
Y/N
If so, List:
Variance:
Y/I
If so, List:
SP's:
Y/N
If so, List: l ��
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3