HomeMy WebLinkAboutCLE201200068 Legacy Document 2012-07-13r-/ W maw-L
Application for Zoning Clearance
CLE # Z -
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 35 Date:
Receipt# F�(n 4- Staff: CYI/KC-,
PARCEL INFORMATIOi^
Tax Map and Parcel: I I Y ) 14 " 1 1) Existing Zoning_ ✓ P b � �y
,/ o_.,
Parcel Owner:
Parcel Address:676/ ��r�l��r C /rC% City C.h4?/_10 7 765/ /1 /eState Zip4Z%/
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: r /V= / /LOCI�C'Q� /�/�3 %/C' (�YCity h�r�l�r � State Zipzz
Office Phone: (` 40 ZI x"7731 Cell # Fax #e546 )Z)3-7491 E -mail j �neekle 14g'/.O, � ,'_f 5_z5oC
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /` /f /Usz�CC�G� �C�C .�/SSVG �l' �c°s ?L. T� �r�dZ'a
Previous Business on this site 7o- G/ , ` of % IL- ' D
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: 4obhh,a�/I�0 %l1CjG/ R'filch - /te11, I7a
S�o�C /ll�is�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 provided
is true and accurate t the best of lm wledge. I , ave r ad the conditions of approval, and I understand them, and th t Ipwiillll/l abide by them.
Signature (✓t - j Printed &//fie„
ArFR" v 1 T , 1NPORMATION
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 J Date 65 ; -Az %z
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
'Corer i
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Intake to complete the following:
Y /'N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y!
Wil 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 o CP1141licilent r?
If private well, provide --- form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap lies
Is arcel on se ti r public wer?
Reviewer to complete the following:
Square footage of Use: Z-Z— 6.-,'
/N
ermitted as: M �,�; i ,n 1 G� ��) �a-
Under Section: Z� �i • 2
Supplementary regulations section:
Parking formula:
Required spaces: ,Q
Y / 1V
Items to be verified in the field:
p 1?
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 #
Motes:
Violations: - -
Y/ .7
If sd list:
Pro rs:
Y�
Ifs , ist:
U
Variakee:
Y/ 1
If s , ist:
SP's:
Y /'T
If s , ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3