HomeMy WebLinkAboutCLE201300252 Legacy Document 2014-02-05Application for Zoning Clearance_:;''
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PLEASE REVIEW ALL 3 SHEETS
OFFICE O
Check # 41 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: —3 L1-0(f-<O � Existing Zoning
Parcel Owner:
Parcel Address: �Q `7/ U km t r-" �1�`j� City C U State LL Zip
—
( elude suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
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ter. Pd. City A61k (, �� State Zip Z45 S
Address : � •
Office Phone: L )63L Cell # Fax # E -mail CV PLL.0 62 0 •C.o W
APPLICANT INFORMATION
Check any that apply: Cha ge of ownership change of use Change of name New business
Business Name /Type: o- &41 ® �e
Previous Business on this site A(DY.� 4e—
Describe the proposed business including use, number of employees, n}�mber o ifts, a �iible kin aces, number Qf
vehicl s, and an 1 information that yo can provide: Jai &.e cd
*This Cledrance ivill 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 ' 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�t th best of ,ly knowledge. I have read the conditions of approval, ani -bnderstand 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, x117.
[ ] 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 3
Zoning Official ! Date Z�S�ZvI
Other Official `" Date
County of Albemarle Department of Community vevetopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/®
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
Circle the one that applies
Is parcel on private well or �eppartment r?
If private well, provide Healt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or u is sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ; �i /3 —7-- ./' {�
7nninu to complete the following:
Reviewer to complete the following:
Square footage of Use: / d d
I N
Permitted as: A Ori'1� o
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /I�
If so, st:
Proffers:
/ N
so, List:
Vari ce:
Y/
If so, is t:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3