HomeMy WebLinkAboutCLE201200121 Legacy Document 2012-07-13Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 1 Date: -
Receipt #Mqo Staff:
PARCELINFO
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arcel. � Existing Zoning _ 10
Tax Map and Parcel. (� I�.J! 01r)
Parcel Owner: iF N tnnu n L k a.b: ) f'4-\,% Ti-,S+
Parcel Addressd OcP_0 Cotr1a m CxA41!� 5�_' /o City I ( e✓ State VA
(include suite or floor)
PRIMARY CONTACT ++ -� g
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Who should we call /write concerning this project? a in) ti's u ct r;
Address: 1 1 Q :Z L6GA�,S'," 6 -ny-e- L-,- e_ City Ci-.' alew ,'lie, State VA ZipZ_ �n9a 1
Office Phone: ' ,2Z 4.i -0o q3 Cell # S3 %f7 Fax # E -mail OtetG.a a. i yoy_ r 1L°
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 1 kO LL—�. 'T�, �-ic. �'1� as S Big_
Previous Business on this site Le , A
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: la as uS . a Yc� a ers,
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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 t t I wn or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur to to e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Get ..� S Printed awv\
APPROVAL 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.
[ ] 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:
Building Official Date 3c
Zoning Official Date �c
Other Official Date
County of Albemarle Department o Commun' evelo pment
401 McIntire Road Charlottesville, VA 22902 Vote- (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/�
Is ixse LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 r public water
If private well, provide Hea 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 or lic sewe ?
YI/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y 1;
Will.2ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: 0
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ermitted as: Alg,,a�e
Under Section: Z3 -'Z-)
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Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field-
Inspector :
Notes:
Date:
Zoning to complete the following:
Violations:
Y/N
If so, List:
Proffers;
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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