HomeMy WebLinkAboutCLE201300163 Legacy Document 2013-07-26Application for Zoning Clearance
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CLE # l�I "" 163
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # <= Date: 17'cly-J3
Receipt # Staff: 10
PARCEL INFORMATION y� b,A�
Tax Map and Parcel: -^ 5;9 A B Existing Zoning
Parcel Owner:
/ / /
Parcel Address: 10,3-city��a�lu s�ij(L State U Zip ,2?9//
(include suite or floor)
PRIMARY CONTACT
Who should we call //write concerning this project9 .
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Address : � q �Y` - City C� dr c Z&Sudl.- State V/ Zips
Office Phone: 974- E /XI Cell # 90�' �S' 1' Fax # owl` -'�• l a E -mail S- !veQy!i�iN:G �acdca cz�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
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Business Name /Type: � d� deice Pre 4,-4- 5� rl /oe
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
-1) (a-, t� �erv/c�
vehicles, and an additional information thiat.you can Provide: Se
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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 accur e t the best of my knowledge. I have red the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 1 L PI JJ (M . V� L -'z i o�
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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 -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 �i� Date 7/ 2 ��7._� 3
Other Official Date
County of Albemarle Impartment of k.ommunrty >Jeveroprrre IL
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:
Y/®
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/qWill t ere 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 o public water?
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies_
Is parcel on septic o ublic 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 # 9 ,qd /-? - !` c- nL
Zonin to complete the followin :
Reviewer to complete the following:
Square footage of Use: 9 �(
l% / N L
Permitted as: V�
Under Section: yJ� A Z • (� G-- l U�SQ -1
Supplementary regulations section:
Parking formula: /
Required spaces: 13
Y /(
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/6
If so, List:
Proffers:
(/N
so, List:
Variance:
(N�
If so,-fist:
SP's:
Y /
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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