HomeMy WebLinkAboutCLE200900018 Legacy Document 2012-08-27Application for Zoning Clearance
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Zoning Clearance = $35
OFFICE USE ONLY
Check # / (&2' -10 Z. Date: • �� v
PLEASE REVIEW ALL 3 SHEETS
Receipt# -74Q0!5 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 — 2 6 Existing Zoning 2u ra
Parcel Owner: -F-e C ► W S 4 0-s' rW3 o4 +k,#- U V Q
Parcel Address: 10D Z'►'\6VI'(Xa+C•i (24 City (3"4c>*SU a State V #q Zip z�0
(include suite or floor)
PRIMARY CONTACT �/
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Who should we call /write concerning this project? / if
Address: P nj( J t IqdOA AVe- City etAr 0iit•W, //C7State t/11 Zip 2z*
Office Phone: ( (/t (A 19 lu
3 -1199 Cell # Fax # 21G'3 V ? E -mail IN W4 (GJ \
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APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
n 1CAh�ange
_
Business Name/Type: (.C'✓t7T��-- I `�� [J ccNVeC �4 4-16S V-* Z6,11 r Aeer;n 12ett
Previous Business on this site___ / 6'SC'a+%G4
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number o
to
vehicles, and any additional information that you can provide: 1/ 2.0 -e r "r A& 61c(
a r� 'n
*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 t p be of my kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
�� �° �+�►di �'1 SPr1
Signature Printed
APPROVAL INFORMATION
v ] "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 site complies with the site plan as of this date.
Notes:
Building Official Date��`�
Zoning Official ,;di� Date _ %f°/ ��c� ✓
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
I
Intake to complete the following:
Is i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 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/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3