HomeMy WebLinkAboutCLE201200107 Legacy Document 2012-07-13Application for Zoning Clearance
§51' M
OFFICE USE NL
Date:
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # Staff:
PARCEL INFORMATION '
Tax Map and Parcel: D Z 61 O�18 - "'O1 Zi Q0 Existing Zoning
'
Parcel Owner: 7464J tf'OY►1.�5
Parcel Address: Cif to J t [1C'W40 C4City CAAI� State 'UCH- Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : 7i5�75 J�JAA_, f Vt�/� •�,A . City 0 f' r1-� R'� State �CA - Zip �z9s�'
Office Phone: ? Na�oo Co w7 ' P4L
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
C=L. r-L. - (OW i 10y54— b J l45
Business Name /Type: �� OVVI A 1P YV614 &J1 `JI6 QM
Previous Business on this site 0 IJ
Describe the proposed business including use, number of employees, umber s ifts, ilable parking sp ces, num er of
' 0
vehic 1 , and y additional formation that you can provide: e, o d
/o ,S ate
*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 a e the ow er's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to st o my kno ledge. I have read the conditions of approval, and I derstand the , and that I will abide by them.
Signature Printed
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 I ) ( (
Zoning Official a Date 02 / /�y
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
r
Intake to complete the following: Reviewer to complete the following:
Y / N Square footage of Use: ob
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. N /^
rmitted as: 4' ,,a 3 F
Y/N
Will there 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 regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
�7
Dept. FAX DATE �j
Y/N
Circle the one that applies Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Notes:
Violations:
Y /(
If soOist:
Proffers:
/ N
so, List:
�o6
Variance:
If �st:
SP's
If so,Zist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3