HomeMy WebLinkAboutCLE200800244 Legacy Document 2013-03-18L"
Application for Zonin learance
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CLE# �'
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Zoning Clearance = $35
OFFICE USE O LY t f �✓�
Check # Date: // ' e3
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION J LIPTax Map Existing Zoning
Parcel: (y/ l/
and ,
l�/7�V �''w
Parcel Owner:
Parcel Address: %7'q f 96KM e (02UE t ucity 1, r10�State 09 Zip Z250i
(include suite or floor)
PRIMARY CONTACT LL� -t
�� ���� C71910A � 1
Who should we call /write�concerning this project?
Address: �U? P� fV 10fS C! +P— P 3,P5 City CHRt0/_fZ-7StJ1UAtate 1114- Zip 22 '71f
'33r � ax Ofce Phone: Cell # ` E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: c u zo r/ZA Ol c on---ice
/1// 14
Previous Business on this site
Describe the proposed business including use, number of employees, numbe _r of shifts, gailable arkin spaces, number of
eo Prl+ �ACJrL '� i A�
vehicles, nd any add'tional information that you can rov de: � &
11 QY, 1-3 2f1IF -D &S , PI�,eT
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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 owi r have the owner's rnn Sion to use the space indicated on thus application. I also certify that the information provided
is true and accurat o tl st of r y kno e ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
AP�PkOVAL 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 _ (l t � -�
Zoning Official Date 1 O.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 u e ' , HI or PDIP zoning? If so, give applicant a Certified
Engii is Report (CER) packet.
6t, re i be food preparation?
If o, 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 <b1lic. wa r?
If private well, provide Healment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or p lie sew r?
Y/N
Will you be p tting , p a new sign of any ]find? If so, obtain proper
Sign permit.
Permit it
Y/N
Will there be ny new construction or renovations?
If so, obtain t e proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 4�0 d
� ermitted as:�``
Under Section:
Supplementary regulati ns section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Vio s:
Y/
Ifs , 'st:
o
Var' nce:
Y
If o, Li
SP's•�
if i
If s ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3