HomeMy WebLinkAboutCLE200900020 Legacy Document 2012-08-27Application for Zonin Clearance
CLE # °& -C —
Zoning Clearance = $35
OFFICE USE ONLY��
Check # Z/&i & Date:
Receipt # I 9 Staff:
PLEASE REVIEW ALL 3 SHEETS
12
PARCEL INFORMATION
Tax Map and Parcel: 774s7/-/4 Existing Zoning •�- '
Parcel Owner: &42� cog&m o/V
Parcel Address: An.-rA 6r � I city C V1 (iliC�` State / Zip 9_;0;_0
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: K72> City ,y/ L.L. State Zip =90
h
Office Phone: 9 7�f . Cell # Fax # Og E -mail b,m yel-Ca�• nee—
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 1444 -A,/e)171 -A,/e)171 er �9 /K+0i)Y �-<-C- / F_VF, LA 1c11J l OGi -
5T i t_L —r H E%
�, �L�•-
Previous Business on this si�
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:pt,� /P.�S
*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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate the best of my nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
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 G Dated
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:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /D
Will there 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 of pub�ici ater?If private well, provide Hea r men form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aptubl
Is parcel on septic or ic sewer?),
Y /N,
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will there 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: too
ermitted as: ArCw , �! l� 1'I GpLi'1-e-1
Under Section: a-'
Supplementary re l Itiions section:
Parking fonnul : /
I /6CO pwb 1 � e-xc C�'5 erg
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
YA-st:
If
Proffers:
Y/O
If so, List:
Vari ce:
Y />�l
If so, ist:
SP's:
Y/ �l
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3