HomeMy WebLinkAboutCLE201300213 Legacy Document 2013-09-16Application four Zoning Clearance
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OFFICE USI�,p Y Z
PLEASE REVIEW ALL 3 SHEETS Check # I (J Date
Receipt # � Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ 4 , �
(C 02- GZ Existing Zoning Lb
Parcel Owner I u I �.� TtAl 8/ki
Parcel Address: `J� d LI.zStrcc City C�te� r �e>s v; �(� State
(include suite or iroor�
PRIMARY CONTACT
Who should we call/write concerning this
project?
Address: �.� IC I \9&-r V� ! Y` W e City (c�v�e� �; fC State U14 Zip �
Office Phone: (V'O 'g1 Cell# 904=s - -,9,S-ffY Fax #0296 ^ &j'-JL? E -mail �tEc��JGr��c���,�c,�„
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of
`I Change of name tl New business
Iuse g9
lI /
Business Name /Type: e c� C�ov�� C`tEc—L4h esiuehe� hasPr<e l dre�t cGi�nce�E �,
Previous Business on this site �N0 ciA l�� V �-qe- � l)
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: Ve of r,12 s y is' KS nc�fs es
L C. CoPJ- 6�S��OY
i 4 LL°fS Y�uS '(77 i `I
K r;Cc�v U. E C'crr= �`N1 i'vBf to { ceS ne��r C�c_ec - 'u 1�� cc re, w�
"ej -�o ice!° (c�o� e� L°c v 0 Ice iT/�7 : �` S ,114. }�l— P, w; 44r vK,e
*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
CIearance 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 smy knowledge. I have read a conditions of approval, and I understand them, and that I will abide by them.
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Signature Printed i V \ , R e• ( f�:, vt-
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APPROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ Denied
] D D
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x1
[ J 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 - yb Date
LIJ
Other Official Date
. v....V vi n. -jua11c l.- TarunellT 01 l.ommunity 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/(S)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/Q
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 ire one that applies
Is parcel on private well o publi c water?
If private well, provide Heal 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 or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
/ N
-mitted as: G
Under Section: �2 U.,
Supplementary regulations section:
Parkin g formula:.
Required spaces:
Y/
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y / �N.
If so,Zist:
Proffe�s:
Y / 1J )
If sol,�ist:
Vari nce:
Y /�I-
If so, List:
SP's:
Y /
If soZist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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