HomeMy WebLinkAboutCLE201000053 Legacy Document 2013-10-04Application for Zoning Clearance
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CLE #. MID, �; �
OFFICE USE ONLY
Date:
❑Zoning Clearance = $35
1
Check #
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMkTION':*:"':'-"
Tax Map and Parcel: Existing Zoning
Parcel Owner:_
Parcel Address: 15 —1.9 It ky-U, A City CV!2z R_+ State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: LAA(- b'51- City ck,,W�sva61tte A, zip 7-�2--f-70
Office Phone: (/-N, zA•,cS1Cc11 # Fax # E-mail L&_,u-r,_CD0 Ve-< �Ac;)
INFORMATION
-APPLICANT
Check any that apply: _Change of ownership _Changeofuse _Cliangeofname V/ New business
Business Name/Type:(DVR./4"-16Z5t-' A/�00/c E)C7C3je__5AbfT_
Previous Business on this site 4v-LL� 4 � 4
Describe the proposed business including use, number of employees, number of shifts, available parking spaces number of
.iL.Lk
in c 4
leles, and any additional information that you can provide:
f
*This Clearance will only be valid on the parcel for *11iCk 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 infonnatioll provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed .0-vo-
APPROVAL
INFORMATION
Approved as proposed Approved with conditions Denied
BacIdlow prevention device and/or current test data needed for this site. Contact ACSA,977-45ll,xl17.
] 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 —Z (0
Zoning Official I Date 6�2_ /4�
Other Official Date
County 01 AMemarle Department 01 L;0Mn1U111LY.UCVC1UpJU1e11L
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 04/29/08, 10/13/09 Page 2 of 3
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:oA-
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Violations:
SA�
If sod, rst:
if
Intake to complete the following:
Reviewer to complete the follow*
Y / N
Square footage of Use: d
Is use in LI, HI or PDIP zoning? If so, give applicant a Ceitified
Engineer's Report (CER) paelcet.
/ N
Oermitted
as:
Y
Will there be food preparation?
Under Section:If1ti
SDP's
If so, give applicant a Health Department form.
Zoning° reviewcannot - begin --until we-receive!approval•.fromHealth
--- Supplementary-regulations- ection;'• =- • -- - - -- — -• -= =
Dept. FAX DATE
a
Circle the one that applies
Is parcel on private well public water?
Parking formula: / r�
I
If private well, provide Hea t epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces: t
Dept. FAX DATE
1
Y/N
Circle the one that applies
Is parcel on septic or
Iterns to be verified in the field: f�
I A ,3 4 A a —f'
P
i/N
ll you be putting up a new sign of any kind? If so, obtain proper
P gnnrpe # r, '
Inspector : Date:
Nn +ac•
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Violations:
SA�
If sod, rst:
if
Proffers:
Y /
If s6 ,-Mist:
Va Vince:
Y 1W
If so, List:
Y / N
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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