HomeMy WebLinkAboutCLE200700169 Legacy Document 2014-01-22t,
Application for
Zoning Clearance
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
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OFFICE USE ONLY ��J �,
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Zoning Clearance = $35
CLE #
Check # / Date:
Receipt # /� / .� () zv Staff: m
PLEASE REVIEW ALL 3 SHEETS
PARCEL INF MATI N
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1 2
Tax Map and Pa eel: Existing Zoning
Parcel Owner:
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Parcel Address: 3�V "' MW 62NN ONII PPCiiyWO �' "10+2R`03tate V 0'f Zip
(include suite or floor) e2
PRIMARY CONTACT rr V L�'e.l CCG+T't
Who should we call /write concerning this project?
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(19N A)OZ-r`I jf, �Ve v y �(A— Zip ZZ 0
Address: City State
Office Phone: Cell # q�q F2 /'?C"'Fax # E -mail w-m 'Trz Ty
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APPLICANT INFORMATIOND,- 6 1 ' yC� ��
Business Name /Type:
Previous Business on this site �-
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
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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 pennission 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 con ' ' i ns of approval, and II d rstand them, and that I will abide by them.
Signature _ Printed (Y �2 LO
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 - 4511, x119.
[ ] No tysical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
s to
tis site complies with the site plan as of this date.
s:
Building Official �- Date 1 �,
Zoning Official "(N Date 712,ld'
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
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Intake to complete the following:
❑ YES NO
Is use in LI, - or PDIP zoning? If so, give applicant a Certified
Engiryeer's Report (CER) packet.
YYES ❑ NO
there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not e i ntLA rec 've approval from Health
Dept. FAX DATE 1.
YES
s rcel on rivate we or public water?
If private well, Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is p reel o T-u�, or public sewer?
❑ YES O
Will you b up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES tnnew
Will there construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning 'Fech to complete the tollowine:
Violations:
❑ YES NO
If so, List.
Variance:
❑ YES NO
If so, List.
Reviewer to complete the following:
Square footage of Use: qSV
,f YES ❑ NO
Permitted as:
Under Section: - 4jGv-<L )p
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
5/1/06 Page 3 of 3