HomeMy WebLinkAboutCLE200800237 Legacy Document 2013-03-18Application for Zoning Clearance
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OFFICE USE ONL
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❑ Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # -� Staff:
PARCEL INFO ON
Tax Map and Parcel: I4 Existing Zoning
Parcel Owner: Pt 1 0, Pt Feel
Parcel Address: � 0 ( i�GVb�u6, &ty 041,' (tC State �� Zip 2°ZCz
(include suite ok floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : 5 � "r City G V r' State VL'A" Zip 7 Z 1 U 3
42 -M? NIGG /Z r'0Ylt2l�(
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Office Phone: U Cell # Fax # -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership _L / Change of use Change of name New business
Business Name /Type: t°.n
Previous Business on this site �" G
Describe the proposed business including use, number of employees umber of shifts, available arking spaces, number of
X1C�i '
vehicles, an ny additional information that you can provide: U.1G ,i 411; -� l5
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
r
Signature Printed A) ? . i &
APPROVAL INFORMATION;'
[ ] Approved as proposed [t/Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance, with the existing
site plan.
[ ] This si co nplies with the site pla as
_ thy date.
Notes: Pi i O 6 t
Building Official Date
Zoning Official Date / d$
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
a
Intake to complete the following:
Y
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y!/ N
All there 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 lic w e ?
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 app Y<----�
Is parcel on septic or ublic se er?
Y/N
Will you be putt ng up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a y new construction or renovations?
If so, obtain th proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3k % Z4,
Y / N
Permitted as:
Under Section:
Supplementary regulations
Parking formula:
Required spac s:
Y/N
Items to be verified in the field:
tTzz 6v,�X� 7A-4-Ag go tit
Inspector:
Notes:
Date:
Violations:
Y/
If so, ist:
Prplist:
Y
If s
Vari ce:
Y /I
If so, List:
's:
Y/N
so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3