HomeMy WebLinkAboutCLE201300060 Legacy Document 2014-02-05Applic .ti ®n for Zoning Clearance
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OFFICE. L v� y
Date:
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # Staff: ✓/
PARCEL INFORMATION ro- 02-"
Zoning
Tax Map and Parcel: Existing
Parcel Owner:
Parcel Address: .d b0 A #J42 _ City(&RAd4gV; (�State 6 Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
�, r 11 p �
Address : Zs75- �VA I4.1�j City f`kr�fi.�� State `VOA °- Zip
Office Phone: �I7q.z Cell 'VI Fax # E- mail cVPL/�1.f0 p�,cowl
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: '91 ,L 25 +✓acp'5 ®4c—p'
Previous Business on this site AD IAe-
Describe the proposed business including use, number of employees, number of shifts, Y ilable par • nag spaces, nunpb of
vehi les, and an dditiQnal information th you ca prov' e: ►a1 JIO .�� 8 e
*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 tg e est of my owledge. I have read the conditions of approval, an understandiihern, and that I will abide by them.
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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, xl 17.
[ ] 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 I�
Zoning Official ^J.r Bate
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
T
00 -61006
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Intake to complete the following:
YUNN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y QN, Wi re 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
Circle the one that applies
Is parcel on private well or 1parEmeutform. ?
If private well, provide Hea
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o _ ublic
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pe i
Permit #�
i' / N
ill there be any new construction or renovations?
If so, ob
Permit # y
7nninrr fn ommnlafa +hA fnllnwina•
Reviewer to complete the following:
Square footage of Use: �� b
81N
Permitted as: 4Ge55Gy z✓� �jfl %e5
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so,�ist:
Prof ers:
Y/,
If so, ist:
Variwe:
Y /IN
If soil, ?Ist:
SP's:
Y /.
If so, is
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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