HomeMy WebLinkAboutCLE200900051 Legacy Document 2012-08-27Application for Zoning Clearance
�� °�
CLE # 'Y�
�, C7 } -
��RGLN�N
JJ
UT 'r
%1 a A f2
PARCEL INFORMATION r
Tax Map and Parcel: 5 °l D2- CD 1 3 Existing Zoning C-jVy VV\,gX A I b
Parcel Owner: Eno t "Ov,
Parcel Address: ,� '60JH 'MQNJ'7 [-- V IG City C-H kKWTTC \(ILL- c-State V Zip
(include suite or floor)
PRIMARY CONTACT _ -`
Who should we call /write concerning this project? I ( fie �Re� �(�E;1� l ��S /�1� j i,
Address :90( 5 r5-re:, t� City �V�,�jT CA-I State �1-� Zip
Office Phone: (p( n) 1-i7,;o- 3j�}7, "�j Gem K � [ I Fax # (D(() - -mail Edo &V) l�
I APPLICANT INFORMATION I
Business Name/Type: G7U>\1�
Previous Business on this site �1 V'�I (CJ,- E✓f C� j�[ ��(� l ►y
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: K t:7tMiNKGI J�,,
A'i7� �hcl t� °_ 2- �rV�y't���� "} N\- •F q. =c�C9 •- 'S:C�C7 ., Z - W � �(c -S l�i'D ��c^ �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 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 J�i(J Y��'r Printed —e] IJ `k� t�
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 use I1 m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will tere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not MY
ntil we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or p Ir 'c w ter?
If private well, provide He h De ent form.
Zoning review can not b in until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or
Y/N
Will you be putting u a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any ew construction or renovations?
If so, obtain the roper Permit.
Permit #
ZoninLy to comDlete the following:
Reviewer to complete the following:
square footage of Use: (�
Y / N �/`l\
Xrmitted as: 04'T l Gr✓
Under Section: 8 • /
Supplementary regulatiops section:
Parking formula• 1 /k.6 o n6a
Required spaces:
Y/N
Items to be verified in the field:
Inspector : / Date:
Notes:
Vio ns:
Y /
If so, ist:
Prof e
Y •
If S List:
jaril:
:
SP's Y/
If sd, L'
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3