HomeMy WebLinkAboutCLE200800231 Legacy Document 2013-03-18Application fo nin Clearance
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OFFICE USE ON
El Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Check # Z O Date: c�
Receipt # —1 Z (9J Staff:
PARCEL INFO N
Tax Map and Parcel: Existing Zoning
Parcel Owner:
kd�Parcel Address: < y r State Zips
(include ite or floor)
PRIMARY CONTACT
Who should w�e7ca'll /write concerning this project'
,g Q
Address : 2Q Ge if i K-(!iV City State � /64 Zipd`
Office Phone: � �� M�SQ # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: (.
Previous Business on this site —Describe
the proposed business including use, number of employ s, n mb r of s1 lifts, available parkin spat , of
ve icle , and any additional information that you can provide:
*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 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 accur e 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 Printed 01�� �• G tiJ `e
AP 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:
Building Official �— Date (- 43
Zoning Official Date 2 Q 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
Intake to complete the following:
Y/.
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Wilf�tb¢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 well or public wader?
If private well, provide Health epartment 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 lic ewer?
Y /,1q)
Wulf you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
W I iere be any new construction or renovations?
If o, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/ N
ggY�� /rmitted as: &6,6 Q4 &
Under Section:
J
Supplementary regulati¢ns section:
6 1a
Parking fo iLf 460 ,- ' (/ UI,Q�j' .
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violat ns:
If //1
If 46, List:
Prof
If /
If so, ist:
Variance:
Y/
If s , ' t:
SP's:
Y/,J
�
If ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3