HomeMy WebLinkAboutCLE200900002 Legacy Document 2012-08-22Application for Zoning Clearance
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CLE # :W1— '2 -
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Zoning Clearance = $35
OFFICE USE OTY.LY
Checl( # Date: d%'d e `o9
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: de-0
PARCEL INFORMATION
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Tax Map and Parcel: j:YX l.�,j"j� Existing Zoning�i�
Parcel Owner: cJz_'b 7-)o9IC. Ce_Lld
Parcel Address: C W,/ AE-VS C,eCE k City ('10046 -7. State VH Zip 7
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project?
Address: ,29C Oil 0 DoeV? F4,) � � City C.lh94ap77M) to LAII Zip
Office Phone:. 907`7— / Cell # Fax # (� - �r jC '��� it 36c_- Vq
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: ,%�l�jNtS ?� �JJ; r /✓, Tl Ch/r��, �i�'� IUP l,� / / -C(
Previous Business on this site
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: �t 91'" L -5"elt 1f0'6ei,�2iAlf C00 'be-5
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`This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or in t ie u e p 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 lhdt 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 by them.
/abide
Signature �..�li' Printed J �� 1 l YGL ✓L�h`
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, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This ite com lies with the site plan as of this date
✓ OP b dZ1
Notes : l` / wuce, wl 7V1 CI *t4 aVJ
Building Official Date
Zoning Official Date
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 Page 2 of 3
Intake to complete the following:
Is/
Is us n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y In
Wil ,t 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 or public water?
If private well, provide Health Department fofm.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies AIX
Is parcel on septic or public sewe" r?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the pr per Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /
/,'If-
YIN /
'Permitted as: &VCedEi �1'i rPN��f e.cf
Under Section: NW& CO P
IE
Supplementary regul �i section:
Parking formula:
Required spaces:
Y/N
Viola ' ns:
Y/
If so List:
. offers:
/N
f so, List:
v
Variance:
Y/I
If so, ist:
's:
/N
f so, List:
ClearaWels:
O 0 oZ — .'V eZ1,4" CG�z( of
SDP's
G7 P Ic
6
Revised 04/28/08 Page 3 of 3