HomeMy WebLinkAboutCLE200700185 Legacy Document 2014-01-22Application for
Zoning Clearance
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OFFICE USE ONLY - �/'� —J ,r,_
Zoning Clearance = $35 CLE # zo
PLEASE REVIEW ALL 3 SHEETS Check # Date: 7 —
Receipt # f �,% e4 Staff:
PARCEL INFORMATION /�
Tax Map and Parcel• ®-7 (o 0_ J' - Q ~ 0 ()_6®i ,BQ Existing Zonin
Parcel Owner:
Parcel Address: �O� U Gv� tX K city 0-�lo -WrAy &_ State VA- Zip-22 k
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: TJ�wl.C,OA-_✓ �w --c. a- bCityy �" c 1A [e- State QA- Zip 2z-,)
Office Phone: co b �11D ��jl ' 2 Cell # UOr 5?� `AT( Fax # E -mail tY\i k Sn a (� CMa u� : C YL .
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APPLICANT INF
Business Name/Type:
Previous Business on 1
Describe the proposed business, including use, number of employees, number of shifts, available
additional information that you can provide: PSrd Chi f3AaL St -- -ko Sc-- hx $i• ea"
spaces and any
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed y lit �Q �► ��°
APPROVAL INFORMA ION
[ proved as proposed [ ] Approved with conditions [ ] Denied
„ �] "No prevention device and /or current test data needed for this site. Contact A - x ��,,,�,,��//
�/]N o physical site inspection has been done for this clearance. Therefore, it is not a de rin Iii 5�+'i` Nff exiling
site plan. Cunvat Tex Data Needed
[ ] This site complies with the site plan as of this date. Contact ACSA 977.4511, x 119
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Building Official J Date
Zoning Official Date f C 0
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fag: (434) 972 -4126
5/1/06 Page 2 of
Intake to complete the following:
❑ YES Iq O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report ((CCERR) packet.
F-1 YES EO TOIL
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. �onpnva FAXDATE
I�s well or public water?
If private well, provide Hea th Departmen form.
Zoning review can not begin until we receive approval from Health
Dept FAX DATE
O
Is parcel on septic or ublic sewer?
❑ YES [lO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES .
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
, oning Tech to complete the following:
Violations:
❑ YES aNO
If so, List:
FjY7E ce:
S NO
If so, List:
Reviewer to complete the followin
Square footage of Use: 0-
[�YES ❑ NO
Permitted as:`o�
Under Section:
Supplementary re itti ns section:
Parking formult �O
Required spaces: t 3
❑ YES Z NO
Items to be verified in the field:
Inspector :
Notes:
Proffers:
❑ YES
If so, List:
SP's:
❑ YES O
If so, List:
Date:
5/1/06 Page 3 of 3
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