HomeMy WebLinkAboutCLE200900057 Legacy Document 2012-08-29Application for Z o ni � Clearance
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CLE # 2-X R -
R
Zoning Clearance = $35
OFFICE USE ONLY
Check # IQ Zy Date: �"� ' 1 L4 ' Dq
PLEASE REVIEW ALL 3 SHEETS
Receipt # 0 Staff: VSO
PARCEL INFORMATION ^� 0- a �
Tax Map and Parcel: 'TA-A A,,.o 61 m 5e,—hLIM �� . i6 -ee Existing Zoning l� 1
Parcel Owner: 7S Q U C
Parcel Address: —Q01 01 S e m 1 iNo (e Tff I City G�i��lt3 �sV'�,yl� State �' Zip Z2yc�
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 1"SG ✓J 1�1 t� �a.
Address : 3 LJ� yy�c� i' �i -t vt City C i/V + State VA Zip•7D"j01
Office Phone: 9-i6 Y3t Cell # -aq3 c0a-7 Fax # V % E -mail 'b� i, °�i ���L+��iS °F f1�fi
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �� �`, ,`� 'Pre S h Pro A y c- r
Previous Business on this site /'� fi+ 0. w� 4% � - F 1. ac K ( e,
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
v hicles, and any additional information that you can provide: V c C-,, i 4 t at e-1-k 12, 1m�'e'c5
*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 h - read the conditions of approval, and I understand them, and that I will abide by them.
Signature s � v - Printed <L
APPROVAL INFORMATION LL -!� fj�✓j^��v� 1'^�(�t �l�
[ ] Approved as proposed [r/] Approved with conditions [ ] Denied
[ ] Backtlow 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
9.72 1
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 /U
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 C / O
Circle the one that applies
Is parcel on private well o .
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 appl'
Is parcel on septic or blic .
/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wi there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to complete the following:
Reviewer to complete t he following:
Square footage of Use: �W
Y/N p -Q
Permitted as:1���Y 5� e
Under Section:
Supplementary regulations section:
Parking formula: 4y _5'0 x o �j b — 2 J L
Required spaces:
Y /W
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/N
If so, List:
Pro s:
Yk-N j
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