HomeMy WebLinkAboutCLE200700133 Legacy Document 2013-12-13w�
Application for
Zoning Clearance
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oning Clearance = $35
OFFICE USE ONLY
CLE # �t� �% ""- 13
Check # Date: --- 7
PLEASE REVIEW ALL 3 SHEETS
Receipt #�_s,�k °] j Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: c S e__'t ry c-, e t 4/ 1 ). (, ". a'4-� �11fl
Parcel Address:, �) Setn ®dVb J FR City x. 1"1 VLII p State tJ OL Zi O
(include sum or jloo�
PRIMARY CONTACT
k"S
Who should we call /write concerning this project? �� 4 (1
Address: J ()— p , 1 ) ra ` Cit Y 2 � o, State P Zip 9 �4
Office Phone: (G -3v) Gil - `� P7� Cell # 1( 41 24fi -2- 7g6Tax # eq7( � -2-. E -mail g,
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APPLICANT INFO 1 ION n
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Business Name /Type: IJ 1\1 �� T � Le % 7 c N.-O {l
Previous Business on this site e (.�S.�lT•�1
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces 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.
I hereby certify that I own or have the owner's pej the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my know] ge. I have read the conditions o approval-, and I understand them, and that I will abide by them.
Pr- ature Z__ '117 pr- Printed �L! I S
APOVAL INFORMATION
"`"" "'
,Approved as proposed [ ] Approved with conditions em
[VI B cl&ow prevention device and/or current test data needed for this site. Contact ACSA, 9 7 -49*. .�W eV�Ce and/or
M'No physical site inspection has been done for this clearance. Therefore, it is not a deterrnir ati
site plan. Contact ACSA 977-4511, X 11A
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date � o7
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
Vr)
2
D107?
Intake to complete the following:
❑ YES 40
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES U.- �
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
❑ YES ❑ NO
Is parcel on private well or public water?,
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer?
❑ YES O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 'H .,...
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to comDlete the following:
Reviewer to complete the following:
Verm ,u foot age of Use: ES El N tted as: 214. I— ►J / ,
Under Section: d o� • , l
Supplementary regulat�ils section:
Parking formula-
Required spaces: 2
❑ YES V NO J
Items to be verified in the field:
Inspector : Date:
Notes:
Vio dtions:
[VYES F-1 NO
If W. 6 0 List: ^ )- § "1
Pr ffers:
YES
If s :
❑ NO
1 g a
Variance:
❑ YES W/NO
If so, List:
SP's:
ZYES
If so, List:
SP 1�R�-
LRINO
35
5/1/06 Page 3 of 3
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