HomeMy WebLinkAboutCLE200900025 Legacy Document 2012-08-27Application for Zoning Clearance
CLE # C� _ �S
I*-
Clearance = $35
OFFICE USE ONLY ����
Check # 43o is Date: .2
PLEA4Zoning
REVIEW ALL 3 SHEETS
Receipt # Staff: _"C_' (A
PARCEL INFORMATION
Tax Map and Parcel: b 1 — 131% Existing Zoning
Parcel Owner: J`, mo ro 2 ���� C��n�n�' -' Com"
Parcel Address: 1600 Z,,,A 6.4 _. Mi-a City CWAe,5t /A State Zip �a Ci
(include suite or floor)
PRIMARY CONTACT
�4Ve5 1 �2rn��KS
Who should we call/write concerning this project? C.c l e?e�ld�l
Address: I`JOSo 4L6 Ave City State Zip 7/10
Office Phone: (( jo 95`5- Q-1 I Cell # Fax # 7[.2-5771E-mail r f oat Chi a cs�• t.a
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Cdcrc,k — Tf1er'C_Ci'r4A(1'
Previous Business on this site b;e lZeu� Dui 2 ce,Ar%n,i;.j a S{�oces , ope es Vacci.A i. one is �� an �� �flss. iiR�c�s
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
"��/� (�ZZr%S',
vehicles, and any additional information that you can provide: ,t?FT�7i� irk <�3 1C /L %L) e)&-yZ r-.-3
//IIZ,rCii�C•, . A1S /.S iG21 (I' -III 4/ 72
*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 will abide by them.
Signature `-1 � Printed _5 «, i%
APPROVAL INFORMATION
[ /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 siteginplies the s' a pla
0 [hisdate.
Notes: I t h
Building Official Date L( (0-t
j
Zoning Official Date `� �f dl�f�� 0
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 /(
Is usm LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
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 public water.
If private well, provide He tlt-Be ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap�
Is parcel on septic or ublic sewer.
Y/
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
1�/N
ill 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: � 1 &5)
/ rmitted as: 4t; l
Under Section: gk� �,✓ l
Supplementary regulation! s ction:
y A'
Parking formula: "
Required spaces: 1b
Y/N
Items to be verified in the field;
Inspector • , Date:
Notes:
Viol �•ons:
Y /(,N)
If szist:
Prof s:
Y /IY
If so, List:
Varia ce:
Y/�
If so, st:
SP's•
Y/N
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3