HomeMy WebLinkAboutCLE201400159 Legacy Document 2014-08-29Application for Zoning Clearance
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CLE #
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OFFICE5E ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # ' Date: -
Receipt # Staff:
PARCEL- INFORMATION
Tax Map and Parcel: 03Z-00 00-00- 01 1?GO Existing Zoning A-44 4ovL
Parcel Owner: tCh (1✓M -:1-f V i d 'q"('0L-
Parcel Address: /0 G d �7 GO�� ��ity C ,4 1� "Mate � Zip 22
(include suite or floor) /31Vj
PRIMARY CONTACT
Who should we call /write concerning this project?
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Address: ! -0. r�- City 4dn-1 -,1 State Zip
Office Phone: f82- 3777Ce11 # 01 1 Q K4 Fax # E -mail G47W 14z.ecL
INFORMATION
Check any that apply: of ownership Change of use Change of name New business
� /Ch,.ange
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Business Name /Type: Y, xdC;e
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking sp ces, n ber of
vehicles, and any additional information that you can provide: i. kaYW
*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 th caner' permission to use the space indicated on this application. I also certify that the information provided
is true and cu at the best of my dge. I have read the conditions of approval, and understand them, and that I will abide by them.
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Sign atur Printed .,VLI
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
Date 5/-/ Z.9
Zoning Official
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:
'Yl/ N
-1s,,lise in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /0
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 o pu er?
If private well, provide Health Depent form.
Zoning review can not begin until we receive approval fiom Health
Dept. FAX DATE
Circle flee one that appl'
Is parcel on septic or (public 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 #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: S1 D
Y/N
Permitted as: ! 1 e~Q.Yl l/ 0 M) CA-
C/
/
Under Section: "z,M-A
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /(E)
If so, List:
Proffers:
I' /N
If so, List:
% Fr z-7
Variance:
Y/A
If so, ist:
SP's•
Y/0
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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