HomeMy WebLinkAboutCLE200900012 Legacy Document 2012-08-22Application for ZoninT Clearance
CLE # 0760q —/
OFFICE USE ONLY l
IPLEASE
0 ] Zoning Clearance = $35
Check #
REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION �•� / _ �3% G
Tax Map and Parcel: Existing Zonin
Parcel Owner:
Parcel Address: /�l% // (� /lam iU �v✓ ___ City r ~ !' tate v ✓`/ ' Zip L z ?d
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? & GL
Address : ,4q 16La14ey A 6cee H Wlz City &� Llnv#7-4 State V 4 Zip
Office Phone: 4( �y )S�C9`� - 2 �� Cell # ����6 ~�3`�% Fax # E -mail l f}h�'2+z�� fit i�1oii�, co
C �l q3 y 76(P_'F3y7
APPLICANT INFORMATION
Check any that apply: ___/ Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, n mbey of sI�hi�ft,s-,, avla'ilable parking spaces, number of
�M V -'�G)A �41--
vehicles, and any additional information that you can provide: v 5 G+
*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 percussion to use the space indicated on this application. I also certify that 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 abide by them.
Signature Printedt'
APPROVAL INFORMATION
'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 site complies with the site plan as of this date.
Notes:
Building Official Date i
/`l
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902, Voice: (434) 296 75832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the following:
Y/�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 pu 1' wat r?
If private well, provide Health vent form.
Zoning review can not begin Likil we receive approval fiom Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pu i se a •?
Y/N
Will you be puffin g up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any rew construction or renovations?
If so, obtain the pi oper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: d �,k
/N
rmitted as: I
Under Section: sh
Supplementary regulati ns section:
A
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Violat' ns:
Y/
If so, r
i
Proffers:
Y/)
If o,
Var' n e:
Y/N
If so, ist:
SP's:
Y /I�
If so st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3