HomeMy WebLinkAboutCLE200900055 Legacy Document 2012-08-29V'S
Application for Zoning Clearance
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CLE Z,06q —,55
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[Zoning
OFFICE USE ONLY J p D
1-13199 Date: /
Clearance = $35
Check #
PLEASE REVIEW ALL 3 SHEETS
Receipt # '7 1 P, 3 Staff:
PARCEL INFORMATION j 2�
'�� �- E14 � ]ZIT
Tax Map and Parcel: Ct� ,ti�o, acc9- 1's Existing Zoning
Parcel Owner: �1� �k 1 1� ( S A c
Parcel Address: ►C'CC� S�`V1�tle' 1� \iL1�LLCity C�i(�•Cw $��II�EState V A Zip
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(include suite or floor)
PRIMARY CONTACT �—
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Who should we call /write concerning this project? �, 11 G�trin ()r\. . 1 0- 12
Address: /� <if"�r� b f • 3*0 k I e- I b( CityCiV1G � � o�'QS� � i � � State Q Zip
l) CIS 1 -°010 Cell #4ZLA -1. `1-0,)g9'Fax #43 1- q19 E -mail SkCt-y)hd�(\ • `1 Q- -VP_Y\C 0_je le
Office Phone: &34
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APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
iiChange
`
Business Name /Type: K, li ba b_\ NA`' 1�{, 1� \2• `)� 11 "Cr3S i S s 6 C i p L`.i
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, a ailable parking space number of
vehicles, and any additional information that you can provide: Q A �R. Y-eQ C"-�-ac�1h��11�
*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 pennission to use the space indicated on this application. I also certify that the infonnation provided
is true and accur to lest�}olmy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Jv �' Printed 1 &A yo oy\-
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APPROVAL INFORMATION
V�Approved [ ] Denied
[ ] Approved as proposed [ with conditions
[ ] Bacicflow 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 plat} as of this date.
Notes:
J
Building Official Date �- z' t
Zoning Official Date 6 l br1
Other Official Date
County of Albemarle Department of Uommunity 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 LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 ublic water
If private well, provide 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 septic o ublic sewer
Y/N
Will ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to emmple.te. the fnllowinu:
Reviewer to complete the following:
Square footage of Use: r j 0`
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3