HomeMy WebLinkAboutCLE201300233 Legacy Document 2013-10-17Application for Zoning Clearance
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OFFICE USf ONLY i3
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # �'� 0 Staff: L—
PARCEL INFORMATION
Tax Map and Parcel: 7� 1 Existing Zoning
Parcel Owner: S;J�Ja X Mf.v,,,9N i1)P LT&C '
Parcel Address: ��5 �1sU� I�� City (CE�i/IJl ( IG State � Zip
(include suite or floor)
PRIMARY CONTACT _ --
Who should we call /write concerning this project?
Address City PSW State ! Zip U
Office Phone: (N Cell # Fax # E -mail P
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: - 7Em,'+ -p r, ey
Pts Business on this site i►. ��
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:
*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.
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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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and thhaatt,II will abide by them.
Signature Printed
APPROV FORMATION
-[•- ]'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:
Cr 1
Building Official Date f `Z
Zoning Official_.
. Date 1/722 gz3
.--
Other Official Date
County of Albemarle mcparLmeru of wuunuuiLy �cVc F........
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
0
Intake to complete the following:
Y/N
Is use in LI, I-II or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 a lies
Is parcel on Rr vate-Weel r public water?
If private well, rovrd'e ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel or se is or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Willl l
t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Z to com lete the followin
Reviewer to complete the following:
Square footage of Use: �✓UD ��
(2)/N
Permitted as: eYe-
Under Section: M.
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
onm
Violations:
Y/(TO
If so, ist:
Proffers:
Y /
If so, -List:
Variance:
/N
f so, List:
SP's:
J/N
If so, List:
r. �-• �7
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3