HomeMy WebLinkAboutCLE201200176 Legacy Document 2012-08-27Application f ®r Zoning Clearance
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CLE # Zbi2 - IrIt.
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # ZAP52- Date:
Receipt # MC10I5 Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
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Parcel Owner:a LAA, .�n t� y_oy e�
Parcel Address: � (0 Co �PI � Art �a City `��V11I 0 State VA Zipa�
(include suite or floor)
PRIMARY CONTACT ��.p _
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Who should we call/write concerning this project? Jl'
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Address: I500 Cbi,L UAQII t✓-� tA City' State \/A Zip
Office Phone: (I'll ` a Cell #S5 I .: Fax # B, -979-CJ E-mail NMt 1,Gr_6nW 9_� 'aL(
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name Nevi, business
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Business Name /Type:
Previous Business on this site \l
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:'
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or m ve the use to a new location, a new Zoning
Clearance will be required. 31a.a -- g la-(,
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 Printedd t 16` ,
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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, x117.
[ ] 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 Date h, )�
Other Official Date
County of Albemarle Department of uommumty i)eve►opmenr
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/9
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /&
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 or public water?
If private well, provide Health Department form,
Zoning review can not be 'n until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer? 11' 1A
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ViTill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
IATill there be any new construction or renovations?
If so, obtain the proper Permit, `���yt1
Permit #
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Reviewer to complete the following:
Square footage of Use:��
O/N
Permitted as:i �nn e-
Under Section: r IlJLCA. , J2 1'�1c.��5S
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
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Violations:
(/N
If so, List: /
Proffers:
Y/
If so, ist:
Variance:
Y /
If so, ist:
SP's:
Y /6
If so, , List:
Clearances:
SDP's
Revised 7/1/2011- Page 3 of 3
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