HomeMy WebLinkAboutCLE201300094 Legacy Document 2013-05-13Application for Z ning Clearance
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OFFICE USE ONLY rN
Date:
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # 6 16n Staff:
PARCEL INFORMATION
Tax Map and Parcel:hh 061-6pp6 ° DD - d f A j Existing Zoning
/finn
Parcel Owner:
Parcel Address: /GDO A;, City j!� tate Zip'9
(include suite or floor)
PRIMARY CONTACT ��// yy
Who should we call /write concerning this project? 11er/11� 2/I er7il�y
Address: ea go �B'D City 1- '.SAdu r1► State V4 Zip.2101V6
7,43 -7e,3
Office Phone: Cell # ?3,? qy // Fax # 3Z 7XI69 E- mail Y'kennel
APPLICANT INFORMATION
Check any that apply: of ownership of use Change of name New business
Change
Business Name /Type: Ci70.��r� /SVSSC�
Previous Business on this site
Describe the proposed business including use, number of employees, Vumber of shifts, available parking spaces, number of
vehic es, and any additional information that you can provide: -1 h', vr»PnS c %M2S
t� /2
*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 thaatttII will abide by them.
Signature Printed h2 ✓.il 7��/7i�P�'i
APPROVAL INFORMATION
[X. 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 �— Date
Zoning Official `?u. Date ��3 2,z %3
Other Official Date
County of Albemarle Impartment of uommumty meve►opmenL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
YA
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will zere 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 ublic -�
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 applied
Is parcel on septic o public 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, obta' the r P t •t.
Permit
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:SU o
t- /N
Permitted as: I
Under Section:
Supplementary regulations section:
Parkin g formula:
�D
Required spaces: 5
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/O
If so, List:
Proffers:
Y/I
If so, ist:
Variance:
O/N
If so, List: -7 i r nom%
SP's:
Y/0
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3