HomeMy WebLinkAboutCLE200800253 Legacy Document 2013-04-05Application for Z nin Clearance
CLE #-,"7009- X63
Zoning Clearance = $35
OFFICE USE ON
Check # Date:
PLEAS REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION -7 f
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Tax Map and Parcel: / /J Existing Zoning )R/Z
/
Parcel Owner: , 4617
� l c (SaParcel Address: te Zip�v
(include suite or floor) (� (4i
PRIMARY CONTACT
CFr
Who should we call /write concerning this project?
Address so ', . �Aty . `- ►�S�ate Zipa
Office Phone: &9$ c� �Al`i._... -00 e1l # Fax # 2j� dl 1P- -"E,M2 it I C '
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name VNew business
Zn01 10cc ,-fi � a004 h�
Business Name/Type: �6
Previous Business on this site S , r' J
Describe the proposed business including use, number of employees, number of shifts, available parking sf aces, number of� n
vehicles, and any additional information that you can provide: oyu-1 Si
Gt >t Gam✓ G
*This Mirancjwill bly e valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew. 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
thQQatI will abide by them.
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that
i
Signatu e i� Printed e`er -,r6 4 (�SV 1 1nL
APDAOVA 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 4-- a-`
Zoning Official, Date 12 � 8
Other Official " ^` Date
County of Albemarle Department of Community Development
f 401 McIntire Road Charlottesville VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
9 >;, Revised 04/28/08 Page 2 of 3
a
Intake to complete the following:
Is / T
Is useyn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 applier
Is parcel on private well ublic wa
If private well, provide Hea apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o�blic sewer?
Y I/ N
'Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 1
Permit # I� b
Y/N
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /8160
V/ N
ermitted as: rU-FC S 5 l�n ui q t C
Under Section: ,cl- L
Supplementary regulations ection:
Parking formula:
112A a te,
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
Ifs ist:
roffers:
/N
so, Lis • _ � �' r li�"L�75
Varia ce:
Y /M
If so, ist:
SP's:
Y /t
Ifs , ist:
Clearances: " a
SDP's
4•
?t Revised 04/28/08 Page 3 of 3
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