HomeMy WebLinkAboutCLE200800246 Legacy Document 2013-03-18COMMUNITY DEVELOPMENTI Fax 134972,1126 Oct 24 2008 09:36am P002/003
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Application %r Zonin Clearance ��
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PLEASE ,�{'�''•I 1f;, �
A..(i.fEASE '� ��;! '� �l� •'�! ts�
PARCEL ]FOR- IViATION
Tax Map and Parcel: Tu\( M Pcorc c,?-,A Lit fl � Existing Zon?iztg (Yl i Y Pd
Parcel Address: q Zip Q'A''
J` r l 1 1
(include suite or floor)
MCNIARY CONTACT
Who should we call/write concerning this project., kc su
Address: state Nf Zip iam� C ��
5-Ltc7-
ofce phone. (.540)��(� -7a3 Cell# Fax E-mail ca Csi kOt7�l0
.AI'PILICANT LKFOR�MATION
al FAY �i,1;�d+APri: iliiagof:+- �af'it,,_:; y,Isi�ass
Business Name/Type:
Previous Business on this site 1 o \� i 4
]Describe the proposed business including use, number of employees, number of shifts available paxidag spaces, number of
vehlcies, and any additional information that you can provide: rx (� C> - c� �� e v� + y� UJO
�Ur l GC 55d1,i t`5 4-' 000,, 4r re v� t '
by r c ,, Alt, e t 1 !'-L 13c.,r�IInr �nac�5- V2213 Sop c;�c;cal(y�ci��G ?
"'This Clearance wi]l only be valid on the parcel fox wbich it is approved. If you a z_ge, intensify or move the se to a new Ito aa6u, anew Zdr ng.
Clearance will be required
I hereby certify at own or have the owner's permission to use the space indicated on this application, I also terrify that the infoattatio a provided
is true and ace to the best of my imowledge. I have read the conditions of approval, and I uudez!S=d them, and that I will abide by thew.
Sign7ature �- Printed e r-I- O �'
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County of Albemarle Department of CoDnmmtiDity Development
401 mcZntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 ]Fax: (434) 9724126
Revised 04/28,108 Page 2 of 3
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COMMUNITY DEVELOPMENTI Fax d34972026 Oct 2d 2008 09:36am P003/003
Jutake to complete the following:
Y
Is us AT I, HI or YDIP Zonibg? If so, give applicant a Certified
)engineer's Report (CER) packet,
Wil there be food preparation?
If so, give applicant a Health Deportment form.
Zoning review can not begin until we receive approval from Health
Dept. FAXDATE
Circle The one that applies
Is parcel on private well or ublic water?
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 applies
Is parcel on septic or public sev 9
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
y /"
Will ere be any new construction or renovations?
If so, obtain the proper Perrnit.
Permit #
Reiiewex to complete the following:
Square footage of Use: 7L�
/ emitted U. I
1
Under Section-.
Supplementary regulations section:
Parl img formula:
Required spaces:
It o be verified in the Meld:
Inspector, Date;
Notes:
Violations:— -
I/N
SO, List:
-- - -- - - --
Pro:ffers-
N
so, List:
Vari ce:
'K /V
If so, List:
SP °s:
/N
If so, List:
a
Clearances:
A461-)
5T3i"s
/
4
Reused 04/28/08 Page 3 of 3