HomeMy WebLinkAboutCLE201300127 Legacy Document 2013-07-05Application for Zoning Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE US Y �' /1 -�
Check # Date: `t
Staff:
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: 0 4 —' / 07 C 3 .Existing Zoning
Parcel Owner: L L "
` G �i , l'% city (�,t State Zip
Parcel Address:
q M (nclude su2i a or o
PRIMARY CONT ACT Z
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Who should we call /write concerning this project. '//
ZJ / �f�Jl/LI,4/� Ur/ e City C/�RzUrPIl1116 State VA. Zip zZ9al
Address, 3 � (/
Office Phone: (9J3 6J7?3-1319 Cell # q3 -53)• 6,906 Fax # qh- I7L V2 E -mail b IocXew P `Oierrrv„ Eetcmc, cL „
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
✓''
Business Name/"type: 1 � ��'J e o, i1U ,
Previous Business on this site le- l n T 5Z= ay ey e—
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additio information that you can provide 6f=f =l c� FOC F(Ut4c CIce fKt� =-P /arnlar»
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eri� e5 S!'1 A5 ee i ed /=od 6 49{ »;-tn! C6 rr�
*This Clearance 4Adll only be valid on the parcel for which it is approved. If you change, intensify or mov the use to a new I cation, 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 certif . that the information provided
is true and accura o the best of fuy k totwicdge. i have read the conditions of approval,, and [ understand them, and that I will abide by them.
L / lz Printed tI L C /CeA
Sign /�LLI �+7 �DP,Uee
APPROVAL INFORMATION
Approved as proposed { ] Approved with conditions Den.Back:flow
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prevention device and/or current test data needed for this site. Contact ACSA, 977 -45 .l, x .1.7.
No physical site inspection has been done for this c.learatim. 'T'h.erefore, it is not a determination o mpli the existing
site plan.
[ ] This site complies with the site plan. as of this date.
Notes: _
Building Official Date (/� (1 ( �
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 N clntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 .Fax: (434) 972 -4:126
Revised 7/1/2011 Page 2 of
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Intake to complete the following:
Reviewer to complete the fallowing:
Y / N
Square footage of Use:
Is t, n LI, HI or PDI.P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Permitted as:
Y ri
SP's:
Y/N
If so, List:
Wii ere be food preparation?
Under Section:
If so, give applicant a Health Department form,
Zoning review can not begin until we receive approval From Health
Supplementary regulations section:
Dept. FAX DATE
Clearances:
Circle the one that applies
Parking formula:
Is parcel on private well ?a �-Wvyate
If private well, provide He h-llep rtment form.
Zoning review can not begin until we receive approval from Healtli
Required spaces,.
Dept. FAX DATE
Y' /N
Circle the one that ap '
Items to be verified in the field:
Is parcel on septic o public sewer`s
Y N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
:Permit # l'J
Inspector : .Dates
N
D
Notes:
ll there be any new construction or renovations?
i1
If so, obtai the
o e Permit,
Permit
i
.Uvj,t ll 3V {rV la3
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, 'List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP`s
Revised 7/112011 Page 3 of 3