HomeMy WebLinkAboutCLE201400198 Legacy Document 2014-10-09LIM, 0
Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
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Check #`V V Date: (> "� `�
Receipt # Staff:
PARCEL INFORMATIO�j F n
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Tax Map and Parcel: Existing Zoning
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Parcel Owner: l C�,
Parcel Address: N13?- ..mac - X 3 6 ), 11) n ")/ rP )14" . City Cam'; r )6 ) A) tate VIA Zip 6�
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project9
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Address TO �D� 3 7d) L City � A11,," C fl State Zip
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Office Phone: c7vy� Cell # Fax # ��1��`���n E -mail �✓q L� C C�t,TQ CO fro
APPLICANT INFORMATION
Check any that apply: Change of owrnershipJ Change of use Change of name New business
Business Name /Type: 0
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Previous Business on this site
Describe the proposed business including use, number of employe , number of shifts, v)ail ble parkin spaces, number of
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vehiFles� n, Sany addition #1 information that you can pr vidf: � �� / -C�- V
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*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.
1 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 of mA knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ _ X n-o -,P � 6! �
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APPROVAL INFORMATION
_P14' 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 Officials e Date j I / fJ
Zoning Official �✓ Date l�/
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
t Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/(M
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will ere 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 public w r?
If private well, provide H61Gh- Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or blic sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
4 / N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# 2t)tt1-`63y
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 7V 6
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Yc�f+91�
Permitted as:
Under Section:
�Z-S" , Z
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Supplementary regulations section:
Parking formula:
Required spaces:
Z
Y/
Varia ' e:
Y(TII
If so, List:
Items o be verified
in the field:
Inspector : Date:
Notes:
Viola 'ons:
Y/ V
If so, List:
Proffers:
6/N
If so, List:
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6, S
Varia ' e:
Y(TII
If so, List:
i /N
If so, List:
--31
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3