HomeMy WebLinkAboutCLE200800261 Legacy Document 2013-04-05Application for Zoning Clearance
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�� Zoning Clearance .= $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O Y �} P r�J
Check # 7 Date:
Receipt # Staff:
PARCEL INFORMATION P-e— sns o�GGv- �3-� -�LPV) 0,�6GO- G'3- oo-do? v
Tax Map and Parcel: o 76ca-o3 B o ; o ;�EGo -03 -cam- L4 o Existing Zoning
Parcel Owner: 3 ohs S l7 ar�� // o i jr�h G • L7G ir�r/
�%S /- uti�GoNGi D�,�� 6-4 City C, /,tii4/44 � //t State
Parcel Address: 5 Zip 2ZCla�
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(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: Tc- 3 FGG I �vh.. D�,'�� . S City G /v /,4s -/ %6. State lip Zip 2,2-,q0
Office Phone: (`/ IV) Cell # Fax # �3 y -�;z 9--631,7 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ovvnersh�p , ' _ Change <of use `.. Change of name New business
Business Name /Type: Du /rell 11 2 4 G /- Z`'+"`s h /f�y�f °1�•/
Previous Business on this site s
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: 61 Fc.
*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.
Signature / ! Printed / Z /S z c:,,
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APPROVAL INFORMATION : ;
Approved as proposed : [, ] Approved with conditions [ ; ]Denied .
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451.1, 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 plari-as of this "date. ` -
Notes:
Building Official �- - Date . i t 0
Zoning, _ .
ing Official Date %22G�
Other Official D ate
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:
Y /n,
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will. there 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 orLpuhli - wa-ler?
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 ap - l'
Is parcel on septic Qk2Hblic sew .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoninpr to com lete the following:
Reviewer to complete the following:
Square footage of Use:
r/a'7
6
N
Permitted as:�-�
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viola 'ons:
If If`o ist:
Proff s:
0/
If so',`�ist:
Varia ce:
Y /T
If so, List:
SP's:
Y N
If so, List:
Clearances: ---
SD '
Revised 04/28/08 Page 3 of 3