HomeMy WebLinkAboutCLE201200141 Legacy Document 2012-07-10Application for Zon' g Clearance
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Zoning Clearance = $35
- PLEASE REVIEW ALL 3. SHEETS
OFFICE S �Y s
Check # `tCJ� 1 Date `2� `� Z
Receipt # n
Staff: MAQ
PARCEL INFORMATION
Tax Map and Parcel:Ulo_I W o ,o1 - 00- 1 op- W Existing Zoning 4gibi a Npon Manir�,
N J�!` •D
Parcel Owner: A N y 1 iJ c r 1..-/-41..1 D —CR USr--
Parcel Address: -:340 City r W I 1-mbfut Lga State VA Zip 2290
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this proiect? SV r- A. A t13ct,r�r
Address Zip
,C State Z29pi
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Office Phone: ( 101 _ Min .5-71' A _7 E -mail .5vzC a DfSiI,►/rN0I 7 e0,yc
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ES11nlJ Ire-AU t% nty,C' C o 2PpflAjJ— Ljt4
Previous Business on this site .J A Z2. IZO-Ct5 ><
Describe the proposed business including use, number of employees, number of shifts,. available parking spaces, number of
vehicles, and any additional informations that you can provide: Co �+Cnd l�i�� t-r-eiWOC Ui?r= j q "AV
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*This Clearance will only be valid on the Parcef 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.
Signatur Printed SUE. A . Q L J3 ag -r -14
APPROVAL INFORMATION
[L4—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: AAIA gall - 05
Building Official `°� �— Date Z��(
Zoning Official Date 7- La I IO�
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 04/28/08, 10/13/09 Page 2 of 3
Intake to complete the following:
Y / To
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /,�qD
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 well or lie wa r?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic blic se r?
Reviewer to complete the following:
Square footage of Use:
/ / N a0�
ermitted as:
Under Section: �v A IE mx d
Supplementary re ul 'on:
Parking formula:. 6611A
l
Required spaces:.
Y/N
Items to be verified in the field:
Y / lD
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y /� Notes:
Will there be any new constriction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/N
If so List:
— Y / N
If so List: '
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Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
V
Clearances:
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SDP's
Revised 04/28/03, 10/13/09 Page 3 of 3
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