HomeMy WebLinkAboutCLE200800238 Legacy Document 2013-03-18Application for ZonliN Clearance
CLE # X00
�'IR(aN�P
oning Clearance = $35
OFFICE USE ONLY
Check # 2-q0 2, Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7WS J Staff: secq
PARCEL INFORMATION
I 61
Tax Map and Parcel: E C — Existing Zoning
Parcel Owner: � AA V "_V z
Zip
Parcel Addressiw Amms FI V A • City State V A
(include suite or floor) 5uh_ to
PRIMARY CONTACT
Who should we call /write concerning this project? da dl z
�iifi� co UV'F JQ V_ 4ate 0 Zip
Address :� City .a V l
Office_Phone:r��1 ��3. Cell # . �'y *. i f� c ' ' `, ,
�� . '' ` Paz # h E -mail P7 .1/� W� ���'('VI/
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _ Change of name New business`
Business Name /Type: C V1 1) t AK4 -works uyY 'u�4
Previous Business on this site js
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Describe the proposed business including use, number of employees, number of shifts, available p "Arkingisp ces, nu m er of
vehicles, and any additional information that yo can,provide: h
S
S
*This Clearance will only be valid on the parcel for whiel it is ap oved. If y hange, intensi a the seU!a ne caf new Zoning
Clearance will be required.
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I hereby certify that I own or have the owner's percussion to use the space indicated on this application. I alsq certify that the°infomiation provided
is true and accurate to the best of ry knowledge. I have read the conditions of approval, and I understand4lQe , and that by them.
rlwill'abide
Printed R d, &Hoke n
Signature ii l
APPROVAL INFORMATION
y]fApproved 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
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
7�
�Y�CS
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Intake to complete the following:_ R
Reviewer to complete the following:
Y / N S
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. d
d / N i
Permitted as:d .i
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health S
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies P
Parking formula:
,GJiJ
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health R
Required spaces:
Dept. FAX DATE
Y /6N
Circle the one that applies I
Items to be verified in the field:
6 / N
'11 b t
i you CPU ing up a new sign o any an so, o am proper
Sign permit.
Permit #
Y /�
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnin4 to emmnlete the fnllnwinu:
Inspector:
Notes:
Date:
Violations: Proffers:
Y /6) Y / ri
If so, List: If so, List:
Variance: SP's:
Y16 Y/b
If so, List: If so, List:
Clearances: SDP's
67-��7V /--j
07-- 2o::7
n -7
q -- - 6.S
Revised 04/28/08 Page 3 of 3
Revised 04/28/08 Page 3 of 3