HomeMy WebLinkAboutCLE200900009 Legacy Document 2012-08-220
Application for Zoning Clearance`
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CLE # 0
Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: • 9
PLEASE REVIEW ALL 3 SHEETS
Receipt # c Y&'7 Staff: ')La
PARCEL INFORMATION '
Tax Map and Parcel: `rM Is T" us C r4- Existing Zoning Hu u Ccknmm�
Parcel Owner: �C1 �V' l •LS I J
Parcel Address: 199 SpolkiCAO I` City C1lcm-1A6wVi State td State-VA 9 l l Zip
(include suite or floor) J�
PRIMARY CONTACT
Who should we call/write concerning this project? ffla(may Q t L U V4 AV ib,
x
Address: lq5 � k�l?/1�( 11'VL City tl State VA Zip -L-,n If
Office Phone: 8%, 979 - 9&�Il # b Fax # Xt (p • 3y (Q E -mail V ( ,
Y7 0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name/Type: 1
Previous Business on this site l t vl t
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: Rea.[ ask -u }2_ Sul ac - H ,1Q lcox 0-sT
*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 th a I o or h he wner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur oPkno I dge. I have read the conditions of approval, d I understand them, and that I will abide by theme.
Signature Printed 6T
APP ' OVAL IWORMATION
[ U Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] 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 3�
Zoning Official Date 6 b
Other Official qJ, Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesvihe, VA 22902,Voice: (434) 296 -5832 Fax: (434) 972 -4126
pRevised 04/28/08 Page 2 of 3
I
Intake to
Y / `:l
Is use m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Wi
Will 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 o 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 public sewer?
Y /NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
S e footage of Use: 0
PN Pp
ermitted as: I' (il d �"-D mat 6-ca-c--
Under Section:
Supplementary re n ons section:
Parking form a:
I Zo o A&
Required spaces:
Y/
Items to be verified in the field:
Inspector
Notes:
Date:
vio tions:
Y
If so List:
Proffers:
Y /
If s , ist:
vari
Y/
If so, List:
SP's:
Y/0
If so, List:
Clearances:
SDP's
f
Revised 04/28/08 Page 3 of 3