HomeMy WebLinkAboutCLE201200229 Legacy Document 2013-05-13Application i ®r Z®nin Clearance
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OFFICE USE O �Y /h L` (I/�
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PLEASE REVIEW ALL 3 SHEETS
Check # Date: G
Receipt Staff: ( f
PARCEL INFORMATION 4 d1-11t17,,
o " �� _ Existing Zoning y
Tax Map and Parcel:
Owner: G// Vlc/�1� /�
Parcel
Parcel Address: � State *° Zip 9IZ , /Zay `
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address :4 vS �t L6 C'L: S-r City (�!,\/ kk- tz. State VA Zip2z- co
Office Phone: Cell# -5Ae,,,Z Fax# E- mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 0 VI-TL a
Previous Business on this site c-N 1 '-�A L,Q &K \vtiu
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:
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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 acc rate 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 i Printed<_�--FF• LNr- —k tt- ,
APPROV L INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 Lk 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 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y /Q
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y�/ N
li11 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 or ublic w er?
If private well, provide Healt apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie�
Is parcel on septic or ptt tc sewer?
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 # 4611— /� 9:
7nninu to complete the following:
Reviewer to complete the following:
Square footage of Use: l642-0
Yr it j
ennitted as: C�
Under Section: 2--2 ' L �2. 3
Supplementary regulations section:
Parking formula:
q5 sf oQ
Required spaces:
Y/0)
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /
If so, st:
Proffers:
Y /
If so, tst:
Variance:
Y/
If so, tst:
SP's:
If so, Est:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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