HomeMy WebLinkAboutCLE201300176 Legacy Document 2013-10-17A pp lication for Zoning Clearance
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OFFICE E Y
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff.
PARCEL INFORIV> ATJ N
Tax Map and Parcel: (( ��pp ` Existing Zoning
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Parcel Owner: Lp� l'1ti14 i� t.L Z J4^-L� t-t- L LC
Parcel Address: �SU� OI � 7V City (�HY¢RL�tSVI` f&te V �' Zip2„2u
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? R�—uj 96-EF y\&vvN
Address :25J trL C'A11U4mpr bF,, Citye�r/4 /Zlb/kM State VA-- Zip9t
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Office Phone: Cell #YO)411- ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: 1 ..
Previous Business on this site LJZA- 5q ELL S PA-cG _
Describe the proposed business including use, number of emplo number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide E. ,
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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 accu e o the est of kn ledge. I have read the conditions of approval, and I understand them, a d that I will abide by them.
Signature Printed
APPROVAL INFO ATION
]'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 / 6 l
Zoning Official `" �✓ �� �, Date /��1
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
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 1'fli
Wil 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 or i
If private well, provide 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 septic or ublic se erg
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
ill there be any new construction or renovations?
If so, obt ' e roper, Permiu .
•
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
.�/N
Permitted as:
Under Section:. p. k
Supplementary regulations section:
Parking formula: `� •��!
Required spaces:
Y /
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
O/N
If so, List:
Proffers:
V/N
If so, List:
ZQ f,_l
Varia ce:
Y/
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
W ! io
Revised 7/1/2011 Page 3 of 3