HomeMy WebLinkAboutCLE200700085 Legacy Document 2014-04-28`i
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Application for
Zoning Clearance
OFFICE USE ONLY 7— o 07 - -,' —5
B-Z-0-ning Clearance = S35 CLE #
PLEASE REV W ALL 3 SHEETS Check # , Date:
Receipt
PARCEL INFORMATION
Tax Map and Parcel: �MT
Parcel Owner: sentfsq I I c
Existing Zoning (?- -
Parcel Address: Iwo Ci State Z {p izZ o
(include suite or floor)
PRIMARY CONTACT flJdL6T-P4
Who should eve call/write concerning this project? �ul i ET
Address: P.O . �o� $ b (p lQ City (2 hPAJ0 J k State �R Zip 22 96L,
Office Phone: i_, Cell #Ro$3&,-�aa # E -mail ah jit:E-t-r� c� Comew sr. N
APPLICANT INFORMATION
Husiness Nsme/Thm: 1C A p,D L&
Previous Business on this site \) ,AG' A N T
Describe gibe proposed business, including use, number of
additional information that you can provide: ('Wf C e5
number ofshi4 available parking spaces and any
-AR
011is Clearm uz will only be valid on the parlxl for which it is approved, lfyou change, intensify or move the use to a new location, a new Zoning
Clearance Will be required
I hereby certify that 1 or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and l c c to best o owlcdge. l havo rcad/tthhe conditions of approval, and l understand thcm` and that I will abide by thdm.
Signatur _ �k1 EItS /l Printed �r'E'i
INFORMATION
[
)Approved as proposed M Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x 119.
[ ] No physical site inspection has been done for this clearance. Tbereforc, it is not a determination of compliance with the existing
site plan.
[ ] This site compli with the site plan as of Eh'- date.
Building Official c Date / 1
Zoning Official Date G l
Other 0mcial Date
County of Albemarle Department of Community Development
4 01 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
3/1146 rage Z oo
Z 3
Intake to complete the following:
® YES LINO
is use in LI, Hl or PD1P zoning? If so, give applicant a Certified
Engineees Report (CER) vwket.
❑ YES M—'90
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval
Dept. FAX DATE
M-YES p' NO
Is parcel on private well orpublic water? -
If private well, provide Health Department form.
Zoning review can not begin until we receive approval
Dept. FAX DATE
[D,Y S ❑ NO
Is parcel on septic or public sewer?
Reviewer to complete the following:
Square footage of Use:
YES E3 P � rKi l �j
Permitted as: �— _..�,_._.�.
Under Section: 1- 7) - a- ' a- C-1
from Health Suppl men regulations s lion:
-7i
Parking 10 Lila:
Q &6)
from Health Required spaces:
YES ErNO
Items to be verified in the field:
p S p�lvO
Will you be putting up a new sign of any kind? If so, obtain pprroopp/er
Sign it.
Per it C� i/'� U - "
#
YES D-NO '-
Will there be any new construction or renovations?
If so,.' obtain the proper Permit.
Permit # (3 IC — AV / N
to
❑ YES � NO
If so, List:
varis uce:
0 YES [-I NO
l f so. List:
V 2 C1Q 7 �t i i 4t
VV o N AitUd
Inspector - Date:
Notes:
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