HomeMy WebLinkAboutCLE200800132 Legacy Document 2013-01-1706417/2008 12:22 FAX 14342932335 CANON [a 001
Applicaton fo° onin Clearance
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PARCEL INFORMATION
Tax Map and Parccl: Q °7 j 0Q• Q C -- 0130 Existing Zoning Cc lrYl ry-)
Parcel Owner-
Parcel Address: 3 i �C x _, C -' , State V a Zip
(include suite or floor)
P1REVIARY CONTACT
Who should we callhvrite concerning this project?ry�,��,- �Cp��F(�� f — -
Address : � �Zr W G� ��(Tity _�! �,V� t e .t_! `+tstate _ \l a-- Zip zao i
Office Phone ell!
�160*,J�q t P-26 Fax 33 { E -mail
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APPLICANT INFORMATION
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Business Name/Type:
Previous Business on this site
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Describe the proposed business including use, number of employees, number of shifts, available par in spaces, number of
vehicles, and any additional information that you can provide: 4& S
°This Clearance, will only be valid on the parcel for which it is approved. if you change, intensify or move the use to a now location, a now Zoning
Clearance will be required,
1 hereby ccrti that 1 own or have, the owner's perinission to use the space indicated on this application. I also certify that the information provided
is true and cur to to the I est o knowledge, I have read the conditions of approvul, and ��i}}un4crstand them, and that I will abide by them.
Signature %� Printed
APJP o I 'O ATION
[ .: Approved'as proposed [ ) Approved with conditions Denied
[• Hacicf7om,- Trevendon device and/or ourrent test data needed for this site. Contact ACSA, 977 -4511 119,
[ I' XJ'o'physical site..inspecdon has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site Plan.. '
[ ,..j•xhis side cotholies. with'the.site plan.as'of this date,
)E >ttl>tdf.ng ®t�Fge4al t - A Date. = Y
.Z.004 officill Date 3 0
• .1)ate .
County of Albemarle Department of Community Development
401 McIntire Road Charlottesvilk, VA 22902 'voice: (434) 296 -5832 Fox: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
06.17/2008 12:22 FAX 14342932335 CANTON
0002
Intake to complete the following. Reviewer to complete the following;
a,�LI,HIorPDIPzoning? Is If so, give applicant a Certified Square footage of Use: /'o V'o
Engineer's Report (CER) packet.
Y N fedaS: 6 �
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Are be food preparation?
Under Section:
If so, give applicant a Health Department form.
.Zoning review can not begin until we receive approval from Health Supplementary re rations section: �
Dept, b'AX DATE a d
Circle the onene that s Parking on ula `
Is parcel on vats we or public water? t QS (' Y��
If private well, provide Health Department form.
Zoning review can not begin until we receive approval ti-om Health Required spac
Dept. FAX DATE (P-%� —� GuUA
Y/N
Circle the onpi at a plies Items to be verified in the field:
Is parcel o septic o public sewer?
Y 1 N '7 ` ('2 lie i % G,t/tia dQ
Will you be putting up a new sign of any kind? If so, obtain proper =
Sign permit.
Permit # Inspector: Date:
Y / N 7 Notes:
Will thero be any new construction or renovations?
If so, obtain the proper Permit. in ( k-"-J 1V
Permit # er
,Zonilretr to complete the. fnllnvv4vwnr-
olations:
Y/N
so, List:
Pro ff
Y/
If s0,```���'''St;
va s cc:
Y N
If so, ist;
SPA .
Y
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3