HomeMy WebLinkAboutCLE201400049 Legacy Document 2014-03-27Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# Z Date: 3 ZS y
Receipt # G G Staff:
PARCEL INFORMATION
Tax Map Parcel: -N Existing Zoning FPM Ci
and
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Parcel Owner: J A) r� �� /�%
Parcel Address: &00 T'e- �r J��- ��sa�n T�Weity ciw- V l6tate V Zip
(include suite or floor) ,S-AV- ,'50
PRIMARY CONTACT
Who should we call /write concerning this project?
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Address: C31 I � of I �1 -*3 A0 City SCQ,I1 �`(�(�State --F^X Zip (803
Office Phone: Zc 10) Z 1-9 Z ell# Fax #hd l(i 5 -1Z9'E -mail
APPLICANT INFORMATION
Q `dam
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: 71�'rmat
Previous Business on this site
Describe the proposed business including use, number of employ , nu��(►^_ber of shifts, available pa king spac , number of
vehicles, and an additional infor ation hat on can provide: lJ 1 � 1`
�(IS
1�Y1i c 0 ��
*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 y knowledge. I have read the conditions of approval, and Ijunderstand them, and that I will abide by them.
Sigma /� Printed l 1%Gr �1J` P fd
APPROVAL INFORMATION
[>Q 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 -2 -
Zoning Official Date .31Z -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
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y / O
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will Mre 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 blic ter?
If private well, provide Heal CD pament form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aeublic
Is parcel on septic o w ?
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use
.2o'b
N
Permitted as: A4jZA1 04,(Q-
Under Section: -2, /4 . -2-- /
Supplementary regulations section:
Parking formula:
Required spaces:
Y/ 6
Items to be verified in the field:
Inspector : Date:
Notes:
olations:
�/N
If so, List:
Proffers:
Y/N
If so, List:
Vari ce:
Y/6V
If so, List:
SP's:
Y/
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3