HomeMy WebLinkAboutCLE200700207 Legacy Document 2014-04-25Application for
Zoning Clearance
OF' V, /.
Zoning Clearance = $35
OFFICE USE ONLY
CLE # °L CO 's'_ Z 40 7
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: �`�-- 1 -79Z Existing Zoning rI V
Parcel Owner: � iffbIItU t IIN ff ik i
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Parcel Address: I� 1'1 LV> S2I�IGt�14-� A� #7 City 071H OT /ly-���1ULState ,JL Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project? s t, LA- +,Kcr
Address: 19,(Pq (f+' City State d Zip.229g7
L4 3 4 S � r► C n c�G�•
Office Phone: -0_ Fax # I I-70�E -mail
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APPLICANT INF MATION
Business Name /Type: l QQ) n )o f G Qar �7 ic� I� �Q+�LI Z . L (Z-
Previous Business on this site) /t
Describe the proposed business, including use, number of employees, number of shifts, availpble parking spaces and any
additional information that you can provide: 1
*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 pennission 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, annd�II understand them, and that I will abide by them.
Signature J cu� Printed r 1, Q
ROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 compl' it the site plan as of thi date.
Notes: l % , l7 iI.GV�LJj� 1 g P
Building Official Date s-J�
WZoning Official Date Z � 0
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
. 511106 Page 2 of 3
Intake to complete the following: Reviewer to complete the following:
❑ YES Squar -'footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. YES ❑ NO
Permitted as:
❑ YES [q-9'0 � �+ � Y
Will there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regillat on section:
Dept. FAX DATE
❑ YES ❑ NO /' Parking formul�n
Is parcel on private well or public water? L' `?
If private well, provide Heat ei� p)t� artment form.
Zoning review can not begin until we receive approval from Health Required spaces: / l .�
Dept. FAX DATE /
❑ YES ❑ NO
❑ YES ❑ NO Items to be verified in the field:
Is parcel on septic or public sewer?
❑ YES
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspe or : Date:
❑ YES O r Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
LOMn t I ecll to complete the tollowln2:
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES 2O
If so, List:
511106 Page 3 of 3
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