HomeMy WebLinkAboutCLE200800250 Legacy Document 2013-04-05Application for Zo 'ng Clearance
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CLE # o 2.50
7 �.
� /RCAN�P
OFFICE USE ONLY
# /o �l Date:
Zoning Clearance = $35
PLEA REVIEW ALL 3 SHEETS
Check
Receipt # (a . Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
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Parcel Owner: a � � 1`� � i Y A G >S2
Parcel Address: 1 :1 (16 C&ar yt— City ) U° State V Zip
(include suite or floor)
PRIMARY CONTACT
/write this 1
Who should we call concerning project? 1
Address : C-7 � % e (lC �W C C - City rl04 Q - State 'i 17 - Zip2Z 6
Office Phone: c SS Cell # Fax # ,S UZ E -mail l T1 avuA- el ) �Yti C�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _Change of name AZNew business
Business Name /Type: (2L �i �y �I Y� 6 'k'R 1 i)!:e.
j
Previous Business on this site f, (�,� LAY a i'\V--P, C CY-Yvicc-yVV
Describe the proposed business including use, number of employees, number of shits, available parki spaces, number of
vehicles, and any additional information at you can p ovide. —T (Q Y�q f, --ff $C,l) j n�1 , ;Q-7- /A/[ i �l
d � 1
*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 QfniY knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 1 (l
APPROVAL 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 complie with the site lam as of this da
Notes:
O C
Building Official c 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
cow
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Intake to complete the following:
Y /
Is it I , HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
W 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 o u ter?
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 appli
Is parcel on septic or ublie sewer?
Y/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Pen-nit.
Permit #
Zoning to complete the following:
Reviewer to complete the following: O
Square footage of Use: I . 3
-� I.la1t� L • �1L � � li.
Under Section: K llglo
Supplementary regulation ection:
Parking fornAla:
(/ ?,C 6API
Requir7 `[
Y/N
Items to be verified in the field:
Inspector : Date:
r � L
1� I I Z�� 161 �
Viola ' ns:
Y/
If so, ist:
ffei .
Y/N
so, List:
-r=
Var' e:
If
Ye2ist:
SP's•
If /�
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3