HomeMy WebLinkAboutCLE201200021 Legacy Document 2012-03-01t,
Application for Zoning Clearance
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OFFICE
PLEASE REMW ALL 3 SHEETS Check # { 2_
Receipt # Staff;
PARCEL INFORMATION .
Tax N1ap and Parcel; LO y 1 Existing Zonin
Parcel ! Owner ;„�iYb1,Wt
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Address, I �� i, �, CIO, Vt 't �1 State \(A- Zipzzgb I
Parcel V c`�
(include suite or floor)
PRIMARY CONTACT
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Wbo should we cal9write concerning this •p�r-oJ"t? �0 Ccn UPS -
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Address: - /Zllp,29J4
Office.pbonet U Cell# =LFix# 11: -mail i1�G [1(EU TMtai��
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ApPLTCANT E ORMA.TION
Check any that apply; Change of otivnerslhip Chan a of u-se� Change of flame New business
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BusinessName/Type; i7r� D t�
Previous Business on this site
Describe the proposed business including use, number of employ , numbe of ifts, available p king spaces, umber of
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vehicles, and any additional informadon that you can provide; (, ~
*This Clearance will only be valid on the parcel for wbloh it is approved. if you change, Intensify or move the use to a new loaatien, a new Zoning
Clearance ivili.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 best of my knowledge, Ihave read ibe conditions of approval, and t understand them, and that I will abide by them,
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Signahtre Printed
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AS'PP ORMATION
`[it] Approved as proposed [ ] Approved with conditions • [ ] Denied
[ ] Backflow preventioA device and/or current test data needed for thi &site, Contact ACSA, 977 9511, xI 17.
[ J No physical site inspection has been done for this clearance. Tlierefore, itis not a detenninafion of compliance with the existing
site plan,
[ ] This site complies with the site plan as of this date,
Notes;
Building Official Date
• L . ��� • � .. .
Zoning Of cia Date
l
Other'Official Date 42.
County of.A.lbemarle Department of Community Development
401 MaInfire Road Charlottesv%lle,•VA 22902 Voiee; .(439) 296.583'2 Fax; (dad) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following;
Revielver to complete the following:
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7CoMitflod
Square footage of Use;
Is use in LI, HI or PDIP zoning? if so, give. applica
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Engineer'sReporl (CER) packet,
Permitted as;
Will there be food preparation?
Under Section;
If so, give applicant a Health' Department form.
Zoningreview can not begin until we receive approval from Hoalth
Supplementary regulations section:
Dept. FAX DATE_ Z�%� /mil z.-
Circle the one that applies
Parking formula;
b
is parcel on private well or ublic wa ?
' If private well, provide Health epariment form,
Zoning review can not begin until we racelve approval from lioalth
Required spaces.
Dept RAX DATE
Y /%T-
Mole, the one that'applies
Items o be verified in the field;
Is parcel on septic or c se
ly
/ N
Will you be putting up a new sign of any kind? If so, 'Obtain proper
Sign permit,
Inspector ; Date;
Notes;
Y/N
Win there be any new construction or renovations?
If so, obtain the proper Permit, '
Permit
Zoning to complete the following!
lolationst .. • Proffers.
Y�
/N
If se. List; If sost:
Parlance;
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SP'
IF so, ist:
• Clenran.ces; , ' SDP's ,
Revised 7/1/:011 kage 3 or 3