HomeMy WebLinkAboutCLE200600205 Legacy Document 2014-10-03Application for
Zoning Clearance
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oning Clearance = $35
OFFICE USE ONLY
CLE # ° 2_e3 � to —:z 0
PLEASE REVIEW ALL 3 SHEETS
Check # 4-11:3 :-3 Date:
Receipt # 101h,01P Staff:
PARCEL INFORMATION
Tax Map and Parcel: l� CK J_ Existing Zoning EP " /" 1 C�
Parcel Owner: p Civ 1„LC
Parcel Address: 9C7 t /U� 2l /Go� City �roU�"`l State ��, Zip91I
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this i4 L4 A,- rr
project?
3 % _ Ufa
Address City State /� p .
Office Phone: %Ci "% �� Cell # Fax # 7fl- E -mail
APPLICANT INFORMATION ��
�u�I�C�IJlC �%< re_C_r
11,a9 In
Business Name /Type:
lo ✓
Previous Business on this site
Describe the proposed business, including use, number of mployees, number f hifts, avai able parking s7 Zs and a y
additional information that can Ct� E �r�-�l
you providg�: bk fff r,.�s
• e'` rl�W L°'G /tl P Cz'_$ r z°'G' _ rr l/ • ►'�i/� y
v C% 21,5 --,�-
*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 pe ission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my kn ledge. have read tion s of approval, and I understand them, and that that I will abide by them.
Signature A�con
Printed
AP ROVAL INFORMATION
[\,I/Approved as proposed [ ] Approved with conditions [ ] Denied
[ B ckflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[v]'io 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
Zoning Official Date 3 o
Other Official Date
%A
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 vAJ Z.
5/1/06 P
age obt CJ
Intake to complete the following:
❑ YES :PDIP O
Is use in LI, I zoning? If so, give applicant a Certified
Engineer's Report ER) packet.
❑ YES NO
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
❑ YES ❑ NO
Is parcel on private well o public water?
If private well, provide Heat epa ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is parcel on septic o pu is s wer?
P<S ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
�?IES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
l eCn t0 COMMete the
Vi
[2' YES ❑ NO
List: I so 3/-T�
AS 0 NO M2
Variance:
❑ YES NO
If so, List:
Reviewer to complete the following:
Squar footage of Use: V
YES ❑ NO
Permitted as: " 4 &G
Under Section: ,224, P,l (1)
Supplementary regulations section:
Parking f `rTulla:
/(
Required spaces: a
❑ YES EYNO
Items to be verified in the field:
Inspector :
Notes:
M . /1
M YES ■ NO
If • , lqctg C,
MIAMI
Date:
M
SP's:
�ES ❑ NO
If so, . t
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