HomeMy WebLinkAboutCLE200600302 Legacy Document 2015-02-10Application for
Zoning Clearance
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Clearance = $35
OFFICE USE ONLY
CLE # �
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PLEASE REVIEW ALL 3 SHEETS
Check # q'7q& Date: —/
Receipt # io ,� 0 of Staff:
PARCEL INFORMATION
Tax Map and Parcel: 1 uj o.-03 --00 — 091/10 Existing Zoning
Parcel Owner: Ll�d� ��&ke 6 cty fe, LLc_
Parcel Address:—?-v 0 ` (VMMQYj KeA nt_ 'rdy City t'. G"IDWeS OW1 State V Zip •22��I
(include suite or floor)
PRIMARY CONTACT n
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Who should we call/write concerning this project? � (� tr
Address : '7-a01 Cuw rA a'h VJ e Ih la -r City l 44('r-1D b( c5v►% le y {� Zip 1�D t
33State
Office Phone: L� Cell 43q- 2_1t+ Y-7676 ax# 43w•$- 3.9401 -mail LetCdUEIACIEjSD(� �2CiB1Phi
434• TN�•Z333 ���x�
APPLICANT INFORMATION
Business Name /Type: 1" k ae ( sb l
U
Previous Business on this site GLoczs
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional( that you can provide: .1 h O � - e key° t
�information
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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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature J Printed
APPROVAL INFORMATION
[ V]'' pproved as proposed [ ] Approved with conditions [ ] Denied
[1/]�Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[L- -]'Iio physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existin
site plan.
$aC�CfIOW Device and /or
[ ] This site complies with the site plan as of this date.
Current Test Data Needed
Notes:
Contact
Building Official Date �j �k �� C.
Zoning Official Date
Other Official I4-D" � Date 2/ 2//
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 29f 3
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Intake to complete the following:
❑ YES I 10
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
ER 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 .)a —I 5— d (-P V a
F] YES [ -50 v`
Is parcel on private well or public water?
If private we , pry ovide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is parcel on septic or public sewer?
02'YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # w
❑ YES [ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 1'ecri to complete the tollowing:
Violations:
❑ YES ETNO
If so, List:
Var nce:
LT YES ❑ NO
If so, List:
Vim' -7�
Reviewer to complete the following:
Square footage of Use: �lW
EVYES ❑ NO��
Permitted as: 1
Under Section:
Supplementary regulati ns section:
Parking fold DID D
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
SP's:
❑ YES dNO
If so, List:
Date:
5/1/06 Page 3 of 3