HomeMy WebLinkAboutCLE200800226 Legacy Document 2013-03-18Application for Zoning Clearance
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CLE # 2009— Z Z �
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OFFICE USE ONL
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Zoning Clearance = $35
Check # 1 Date: d
PLEASE REVIEW ALL 3 SHEETS
Receipt # iQ -7-!!;7 / Staff:
PARCEL INFORMATION
Tax Map and Parcel: J i t _ Existing Zoning
Parcel Owner: ( ) I J U K 014 o1= . �FS/ S (� -r S"7 O r= �G4T' %�fL_r /� 'i' �� t �' %S
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Parcel Address: koCity Zi p229 /
(include suite or floor)
PRIMARY CONTACT .� � Z
01rt �/9- 2 %L r
Who should we call /write concerninb this nroject?
Address : City State Zip
Office Phone: (qW) • V 2 3 4s36/Ce11 # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: -mecli OFD f!NZ_9S1P
Business this kx
Previous on site
Describe the proposed business including use, number of employees, number of shifts, available parkii 9 sp ces, number of
vehicles,, d any additional info ation that you ca provi��e%� leJ� c /' c� ,rat
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�Q 4' e A J d�G " t All, (/C� Kct rj
*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 tha n or have ow ri - 's p rmission to use the space indicated on this application. I also certify that the information provided
is true and acc e i best f 1 kno e I awe ead the conditions of approval, and I understand them, and that I will abide by them.
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Signatur i CCx' _ Printedd�2
APPROVAL INFORMATION
[rf Approved as proposed [., ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and /or current test data needed for this site: Contact ACSA, 977 -4511, x119.
j ] 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
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 /
Is us Pin I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil Dhbe 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 or p water?
If private well, provide Health Department-767"n.
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 c s_ ewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. Aj 0—n -Q L-:?�
Permit # C V a /
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # `Z009- 16b /VX Ct r'Le
Zoning to comnlete the following:
Reviewer to complete the following:
Square footage of Use: 25a I
Fermi ted as:
Under Section: �/ or
Supplementary regulation section:
Parking formula:
Required spaces:�r
Y/N
Items to be verified in the field:
Inspector : Date:
Notes: Ii xFz��a�G�
Vio tion
Y/
If o, ist:
Proffe s:
YOy
If so, List:
Var' r e:
Y /�N
If so, List:
SP's:
/ N
so, List:
�7
Clearances:
SDP's O
Revised 04/28/08 Page 3 of 3