HomeMy WebLinkAboutCLE200900040 Legacy Document 2012-08-27Application for Zoning Clearance
CLE #
1*-
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❑ Zoning Clearance = $35
OFFICE E ONLY r�
Qiwe� CNA Date.
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PLEASE REVIEW ALL 3 SHEETS
Receipt # [& — Staft':
PARCEL INFORMATION
PDSO,
Tax Map and Parcel: Existing Zoning
Parcel Owner: i h
p
Parcel Address: C. 0 14, City � `V- p State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : ZLn r� /�Cc��'�t.r Y� City r 7 C MaylU,l_—State U- A Zip ZZYb\
Office Phone: (i{3r/) Z'/ �/ - k�SCy // Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
/
Business Name /Type: PO yl !�0 %��4� (%� le ttiAs /'1
Previous Business on this site
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:
*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--V Printed � a V'_-�a �� N
APPROVAL INFORMATION �. - r�pus�37
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[ ] Approved as proposed [/f 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 :z'
Zoning Official Date s�V
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:
Reviewer to complete the following:
Y -/�Q
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
GIN
Permitted as:
Y /
Will re be food preparation?
Under Section: L,� � Z • /
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
--7
Parking formula:
U
Circle the one that applies
Is parcel on private well ublic w r?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Required spaces:
A
YIN
Circle the one that applies
Is parcel on septic or p lic sew ?
Items to be verified in the field:
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
SDP's
Sign permit.
Permit #
Inspector : Date:
Y ,/
Notes:
Wi there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viol ions:
Y/�
Ifs , ist:
Pro s:
Y/�
If so, t:
Variance:
r) /N
If so, List:
;Is:
/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3