HomeMy WebLinkAboutCLE200700174 Legacy Document 2014-01-22Application for
Zoning Clearance
OB AI Ft
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31-0-n-i-n�9'Clearance = $35
OFFICE USE ONLY
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # Date: 7
Receipt # _4gZ 9 Staff:
PARCEL INFORMATION
bb -6b - 00- i 3` PLD`1S
Tax Map and Parcel: t� k pp Existing Zoning
Parcel Owner: SiVyNoY1 FmC�eC �� ► �y( pl j
Parcel Address:_ 1 Co0C? Q.ib Qr�,QC,\ W - 412-51 k City State \J Zip22pt O
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? SO$ O�l1 K1 ! 2� ''e- w �, �(A2. `C' - A Ones
Address: � kzo E. gatk -\ «reek • -zl I city State MN Zip
Office Phone: 6QP) �J�y 1' 0'921 Cell # Fax Z 4_ -mail Sux'GV " erj es.
APPLICANT INFORIVdTION
Business Name/Type: 37 ;�
Previous Business on this site (, yUi/1 5
d
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: \
peg: G)n�-�=r
*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 o is permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of kedge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �LcUlt Pri nted
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 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 -1 gt, 6-7
Zoning Official Date /�7
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
n
Intake to complet the following:
❑ YES NO
Is use in LI, HI or PD1P zoning? If so, give applicant a Certified
Engineer's Reep,ort t(CER) packet.
Imo" ,
❑ YES 50-
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
R. YES ❑ NO
Is parcel on septic or public sev
❑ YES 5�"NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # . --7
zoning l eeri to complete the
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector:
Notes:
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
Date:
511106 Page 3 of 3
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