HomeMy WebLinkAboutCLE200900041 Legacy Document 2012-08-27Application for Zonin Clearance
CLE # :20— 41
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Zoning Clearance = $35
OFFICE US ON�Y
Check # a Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # '7 q11 % Staff:
PARCEL INFORMATION
}-{- Existing Zoning '(0
Tax Map and Parcel: �'`�h —
/sC�f
Parcel Owner:
Parcel Address: f 6 City Ie State Zip,:.;�
(include suit (\or floor)
PRIMARY CONTACT
/t/�
Who should we call /write concerning this project? o r
Address : 1-2, L4 D F-�- I-J- ob City f a `ks o f I-P State V A-
Office Phone: tf( 34) 015 7dS Cell # qq (1-3 ° 3"? Fax # a5S -370 —1\ E -mail
APPLICANT INFORMATION
Check any that apply: V Change offr ownership .) Change of use Change of name _y_New business
2C - L
Business Name /Type: i v 2s-� 5 d c f
Previous Business on this site 00_ck -�,-
Describe the proposed business including use, number of employees, number of shifts, avai able parking spaces, number of
vehicles, and any additional information that you can provide: c M - f'- 3
-
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C c�J "I `Y Qa-11 a.IL
*This Clearance_ ill only be valid on the parcel for which it is4ppfoved. If y change, intensify or move the use to a new location, a new ng
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 infonnation provided
is true and accurate to e best of my k rowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Z Printed 0z r\ V.
AVOROVAL 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 site complies with the site plan as of this date.
Notes:
Building Official Date
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:
Is / (N l
Is use LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /%N)
Wil 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 on�irivatewe
Is parcel o1 pr public water? �� "
If private w alth Department form. �o BLS
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o ublic sewe .
b/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
�
Permit # 1 >,
/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #`-L
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: / �!
7 /N
ermitted as:
Under Section: �� • !
Supplementary regulations section:
Parking formula: "7 v
�5�Gx. o
Required spaces: /9
Y/N
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Y/
If so, ist:
Proffers:
6/N
If so, List:
oo
Varia ce:
Y/
If so, List:
SP's:
SblN
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3