HomeMy WebLinkAboutCLE201400202 Legacy Document 2014-10-31Application for Zoning Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: 1011/0)d
Receipt # 97 51 Staff:
PARCEL INFORMATION
Map Parcel: m �� 3A 24a6Mr-4 f
Tax and jl Existing Zoning , V
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Parcel Owner: 12e ms P L� a i�a.• cl nrE P-4,r
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Parcel Address:�9//) �E2c�rv�h -R- Ct,_ctE Cit ,_"M- 5V1i.er State U A ZipLZ9D1
(include suite or floor)
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PRIMARY CONTACT
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Who should we call /write concerning this project? (�_e_o c, , rJ
Address : 5 2-- 1) (o �4A L,�e-z 0-6 St.,-rc 31)2- City ,--to —State -)A Zip7_3230
Office Phone: c / 4 377-aP7 Cell # 91) - 337— Fax # A4-2M- E -mail ejty v fir n.
7_75 9, zaa�
APPLICANT INFORMATION 'date
Check any that apply: Change of ownership Change of use Change of name ✓ New business
Business Name /Type: A N r AL —,7TC% in D
Y"
Previous Business on this site i
Describe the proposed business including use, number of employees, number of shifts, avayable parking spaces, number of
vehicles, a, any additional information that you can provide: 1 e_� Q. I 51 df- . 3U ► . ne yeh; c(e S,
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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.
I 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 ac rlrate to the best of my owled e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatu e -' Printed .r/ �91y77✓�.�C
APPROVAL INFORMATION
>4-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 �Y'
Zoning Official Date �z
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
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Intake to complete the following:
Y
Is use I, 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 wel r public water?
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap li
Is parcel on sept' or public sewe I
Y 0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y Ihli
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the followinLy:
Reviewer to complete the following:
Square footage of Use:
6j)/N
Permitted as:
Under Section: �7<4 2_
Supplementary regulations section:
Parking formula:
Required spaces:
Y / Q
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, ist:
Proffers:
Y/
If so, ist:
Vari ce:
Y /(,j&
If so, List:
SP's:
Y /aI
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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