HomeMy WebLinkAboutCLE201300204 Application 2013-09-13 (3)Application f® Z®nln Clearance
I)15' CLE# 204
OFFICE USE 0 -,
3PLEASEREVIEWALL3SHEETSCheck # J Date:
Receipt # Staff:
PARCEL INFORMVON
0 -2--A- Existing ZoningTaxMapandParcel: L 1
Parcel Owner: 1<-/Q B22MIA
U $G S XVLi tn4e city C 1 c State `i, ZipParcelAddress:
include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project ?\
jW 1 11 \E' City 0(m)C- WM(2--State \I. Zip Z25gaAddress: 1121
Office Phone: 6Z) ()\23 -UA Cell
APPLICANT INFORMATION
Check any that apply: • Change of ownership Change of use Change of name New business
Business Name /Type: C N(0)-e- '2-3 -A to o cc4acu-6f
Previous Business on this site :m 1A f o q29DoAr A 6ocA4 -s
Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, number of6e(z fl
vehicles, and any additional information that you can provide: Y`
Je' h 1 • r i csr 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 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 providedistrueandaccuratetothebestofmyknowledge. I have read the conditions of approval, and I understand thee n,, and that I will abide by them.
Signature Printed S 0J
APP OVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ]Denied
Backflow prevention device and /or current test data needed for this site. Contact ACSA; 977 -4511, x117.
J 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. j
Notes: , "i—i)
Building Official Date c:Z 4
Zoning Official " - v
Date hL
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
4711 VZ4
Intake to complete the following:
Y
Is uOu1 LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil 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 public water?
If private well, provide Hea 1-h- ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic public sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permi
Permit #
Y /
1CtdWil re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
dL_ V-11-4
Reviewer to complete the following:
Square footage of Use: 2-5,0 ID
P/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
b
Item to be verified in the field:
Inspector:
Notes:
Date:
L.onm to Wm lele luc 1U11VVV11LA.
Violations:
O/N
If so, List:
Proffers:
Y/
If so, ist:
Variance:
7f /
N
so, List:
SP' / s:
Yl
If so, List:
2'%
zy
Clearances: SDP's
Revised 7/1/2011 Page 3 of 3