HomeMy WebLinkAboutCLE200700182 Legacy Document 2014-01-22COMMUNITY DEVELOPMENii Fax 4349724126 Jun 28 2007 09:16a.m P002/002
Application .'9K,"
Zoning Clear an e
®P'P'I:CE' USE ONLY
❑ Zoning Clearance = $3S CLE
PLEASE �R REVIEW ALL 3 SHEETS Check # )Date:
Receipt ,�: Staff
I
PARCEL INFORMATION
.TION ��y° 00 �` L00 c�00
Za Map and) ?stXcel: Q����� d T��7 _ZxistingZonin -
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Parcel Owner". """'"'�' --�"' "'c•'
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/Parcel 'Address; 4 State
(include suite o Roar)
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PRIMARY ONT CONTACT
Who should we calUwrittee ejoneerning this pr ject7
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N; iVTT FfdSS Cif AIL State
l Address : l�W �. p _ I_ �[
Office Phone- ( l�l�ICell # 152.4 Fax � Z��• 1��� E�gngil (�iYl�re G� � o� 7 TOG Sv
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APPLICANT INFORMATION nn''-- llll " .e r�2?�a.1�� / � l
Business Nante/Type: Dr 14 u Cka rib IT l•�yl %I � 1 1 1 D � � � -
Previous Business on this site
{ Describe the proposed business, inclagdhig use, number of employees, npenbe of shafts, available parking spaces and
I additional inforrnatioa that you man provide
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#This leer noe �vz3i only be va'lzd on the parcel for which It is approve . If'you change, intensify or move the use to a ne+v location, at nin" [:vniri$
Clearance «gill be required. - I � /�bL /' %� I[�OryrS
YlobikVanalli , t Jill be aS Q��.V�Inr 7 VP,nOlrr .l�la
1 ereby certtiy that 10 or eve the ownor s perm�ssion to s e spec., ins � on is is application. T also certify that the informati,p:rn provided
is trice and accurate to the best of my knowledge,l have react tine cord'ztiozzs of apprQ4al, and i understand them, and that i will abide by faerm•
signature — Printed
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APFROVALINFORMATION •- �i�d;l � d
[ J ,approved as proposed �A•pproved with conditio6s [ � penned
[ 1 Backfow prevention device and /oa' current test data needed for this sit4; (Contact A,CS,A, 977 -4511"X119-
[
)No physical site inspection has beers done for Ws clearance, Thereford, 4t is not a. determinatim of compliance with the existiliz,
site plan.
[ J This site eomplies'with the site plan as of this date.
Notts: — —
Building Official
Z011111g off c,ial
Otlaet• official
Date�—�� --
Date
Date
+i✓ortnty of A,lbeinarle Dep;artme;�t 60OoMMlnity development .
441 McIntire Read Charlottesville, VA 22902 Vdi�e: (434) 796 -5837 Fax: (434) 472 -4126
5 /l /06 Page 2 (?f 3 .
COMMUNITY DEVELOPMENTI Fax 4349724126 Jun 28 2007 09:16am P003 /003
Intake to complete the 1000wi0g:
❑ YES ❑ NO
is use in LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
9 YI✓s ❑ No
Will there be food preparation?
if so, give applicant. a Health Department, form.
Zoning review can not begin until we receive approval from. Stealth
Dept. FAX B'A'TE
❑ 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
❑ YI:S g NO
is parcel on septic or public sewer?
[] YES X NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. -fg U(% Sl G N 0 &1 L
I?eranit # v 1) J o. �. Y11 ark Sf •//y�n�
E] YES � ❑ NO Uri li ZDA Cwhip, 04V
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
zojkj 11 Ter-$ to complete the following:
Violations'
❑'BS �eNO
if so, List:
Variance:
❑ YES ZAND
If so, List:
. j
]fie :ne =wer to complete the following:
Squate"footago of use;
YES ❑ NO Is► e✓�
n 2 oo�
Pcrmtticd as: LNC� r '/ c.. ALd lie -Alh;-
'
vndei Section:
suppieinentary regulations section:
Parking formula:
Requir¢d spacos:
Lj YES zn NO
Items'tq b6 verified in the field:
Inspodor : pate:
5, P,
Proffers•
❑ YP-S$/z NO
If so, Lift:
❑ Y>1S, NO
If so, List;
,i
511106 Page 3 of
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