HomeMy WebLinkAboutCLE200800259 Legacy Document 2013-04-05Application fo Z ping Clearance
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Zoning Clearance = $35
OFFICE USE O Lj
(`4"k_# Cc I 1 Date:
PLEAREVIEW ALL 3 SHEETS
Receipt # Staff:
, 2
PARCEL INFORMATION ` �� A-/,
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Tax Map and Parcel: Existing Zoning L, r
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Parcel Owner: I ►
Parcel Address:t��� 01,�{� ucity State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1-44770W
Address /14/W &k/ Zp City SjZ3dL1WQSyjJ16 State JA Zip a22z-
Office Phone: ( 991- WOS— Cell 40W531 -bUoFax JISY)c/ ,V;3$17 E -mail J9A4 ,,Q"INS,C.Vd1L;:rt`c yr91kuLt
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: AMA 1d57-1%vTG rte/- e4W,>71_69V 1I 1G / m4g. l IZ7s
Previous Business on this site /0 pllk
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: / Z %iA� ,y}'i�T ,� � S' WUM2
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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 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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signattl }- Printed _�vn /// lAl
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INFORMATION
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[ oved as proposed [ ] Approved with conditions t , [ o ] Denied ; 'r
] prevention device and /or current test data needed for this site. Contact ACSA, 977 -4- -511•, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determinatioi'i of compliance WTVIIi the existing
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site plan. r'
[ ] This site complies with the site plan as of this date. .y
Notes: !+'
Building Official Date �`� i i�a ,S 'rr
Zoning Official Date r "
0
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
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Intake to complete the following:
Is / �N JJ
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will i 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 or blic Ovate
If private well, provide Healtli Dep ment 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 sewer?
e Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permi /�
Permit # �V "DVJ
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
X400 0 K
Square footage of Use:
Ve1 N
rmitted as: Gt U
Under Section:
Supplementary regulations section:
Parking fonnula� 3-6 �� ,t5'
Required spac'k J
Y/N U
Items to be verified in the field:
Inspector : Date:
N tes: ' cE �i c S e, 6"d4
Viol s:
Y/
If ist:
ers:
Y/
so, List:
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Variance:
Ifs , ist:
SP''
If s't% List:
y
•vY
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Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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