HomeMy WebLinkAboutCLE201300191 Legacy Document 2013-09-13Vtn IN Hr�j
Application fon r Zoning Clearance
CLE # Iq
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ON Y
Check # 2- Date:
Receipt # 7j Staff:
PARCEL INFORMATION
Tax Map and Parcel: ,) - (� Existing Zoning v1/
ParcelOwner:��, -}�(_ ;/l,', 1✓l�.
Parcel Address: fill 91VJ S% SO4 City State 11A Zip 2a I L
(include suite or floor)
PRIMARY CONTACT
n—aC' %
Who should we call /write concerning this project?
Address: e Y`7Q ffl�aa ►'Qi , Sk 3z City )A1'anr.QfJ1 State 'A) Zip
Office Phone: 3c 17 xaSe 14 Fax # E -mail Z SAQ� ' lG.Covy
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: S41 c— G, "'t'vh 1" 1 ✓1 L .
Previous Business on this site
Describe the proposed business including use, number of employeesht�num er of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: ►fr�dr (Q,n,�•r G/I �- �-� r��
IT erlzr'�s
*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 urate to the best of owledge- I ve read the conditions of approval, and I understand them, that I will abide by them.
,and
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Signatur Printed l�7/Tn/ r/ Q (i 1LfC
APPROVAL INFORMATION
'j 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 9E; 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:
�/ N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 or pgb'l c watea?
If private well, provide Health D- Ogaifinent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies ,
Is parcel on septic or, iiblic 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 #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
Y I N
n
ermitted as: '% 4KA C t f w
Under Section: 2 .�
Supplementary regulations section:
Parking formula:
-7-U.�
Required spaces:
Y16
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /�,
If so`�L,ist:
Proffers:
/N
If so, List:
�
Vari e:
Y/W
If so, List:
SP's:
a/N
If so, List:
Clearances:
SDP's
o
Revised 7/1/201.1 Page 3 of 3
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