HomeMy WebLinkAboutCLE200900016 Legacy Document 2012-08-27Application for Zoni g Clearance
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CLE # � q f
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Clearance = $35
OFFICE USE ONLY
Check # 2, 0L Date: d H50
PLEASZoning
REVIEW ALL 3 SHEETS
Receipt # Staff: 1J1�1J
PARCEL INFORMATION p �7 _ �� _ �� Existing Zoning
Tax Ma and Parcel: 7(> / �' q
Map �
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Parcel Owner: f- ('7�j 7�
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d' s State VA Zipl'o 1
Parcel Address: Q — v, -�i. C)
(include suite or. floor'
PRIMARY CONTACT
Who should we call /write concerning this project? "tomi 1. �j��
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Address : , '� , ity C.VX 1DWW' CState
Office Phone: LLWJ q± N, . Celll #'7'3 Fax # 1_[ t" E -mail JQLij,;Un
c? —61000 S-CL iy' i' L'S}oi-Yl1T)
APPLICANT INFORMATION
Check any that apply: Change of ownership Change o.,fuse Change of name J,New business
Business Name /Type: 5d I .IVY to j t 0 A ,� `i ` Q T `eS
Previous Business on this site VJ A
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: s i '
*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I wi;l abide by them.
Signature j7 1, Printed L�� '` ► i�� �t C�Y1
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 sii�ip� ��peoorplies with the si e plan as of tl is date. r
Notes: 04+ice U.-V 15m �-T-; %4r 4410a Jor''5 Yhh{pct
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Building Official Date.i
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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
OW 'k Revised 04/28/08 Page 2 of 3
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Intake to complete the following:
Is /3'� i
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /t1 /�
Will t sere 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 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 / (1
Will i be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y /�Ie
Will be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 65 ! �:
Y)/N _-/�,
ermitted as: � ��i_
Under Section: A
Supplementary regul-naati�i section:
Vv
Parking formula: :d-6 0 rJd,
Required spac� "d'V`'`'
Y/N
Items to be'verified in the field:
Violations:
Y/N
If so, List:
ProffeeAs:
Y /'N)
If so, st:
Variance:
Y / N
If so, List:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3