HomeMy WebLinkAboutCLE200900054 Legacy Document 2012-08-29Application for Zoning Clearance
CLE #
�•arar�r
OFFICE US N Y
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Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt #�A Staff:
PARCEL INFORMATION ^
Map Parcel: �Q, Existing Zoning
Tax and
Parcel Owner: 2 LEC%t✓ -W 4a1_c�i- 6r 0AW FviL
Parcel Address: 0q 111h ft A111/0�: City C, -,dkLP %S!/ /U8S-tate %//I-- Zip2 )I
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? UF60P- n I () Mn-Al t o a-FF— aw) av
Address : 614 W U.W-LC Uwe- City &U/W1,y—j7 S0QCState L/14— Zip?--)cZd
Office Phone: 03A 1-S'2La3 Cell # 2d-5-CIS-40 Fax , #` E -mail I I /)h)44J19 1® I'aba CareS, U5i
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Ltzhange of name New business
Business Name /Type: MAE HU&JW& PL U3 L-1.0—
Previous Business on this site l V If- llb N's "5-c)0-tA -hdA)
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
PRl9U1(1L5 tjki
vehicles, and any additional information that you can provide: I-0 41F n L e,t-2 ylp, S SiK
09PUYVES 17,42— WILL L&C:,- AhjE r-At f C i 7, VE14 &-S O'cWei B i' AGfSMWSS ,
r7 23 d A `X l W1-o` Bry P '214 1'l9r/N.O #V 1-0Y 4(4 f 1 1
*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 , best of my lai ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed L6om 2D e. aCCJ/�N1,�9 -Ai a-k- l e a)
INFORMATION
V]APPROVAL
pproved 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
[G1 &�-
Intake to complete the following:
Y /l0,
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y /N)
If so, give applicant a Certified
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 public water
If private well, provide Heat i epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer
Y/O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
footage of Use:
IN
rmitted as: C.L'i
Under Section: Q t
Supplementary regulat I ons section:
Parking formul 1-4-00
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol��ons:
Y/
If so ist:
Proffers:
Y/N
If so, List:
Variance:
Y/
Ifs ist:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3