HomeMy WebLinkAboutCLE200900058 Legacy Document 2012-08-29Application for Zoning Clearance
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CLE # 2,00 - S�
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Zoning Clearance = $35
OFFICE USE ONLY,
Check # A/ od Date: Z1 �s• `�
PLEI REVIEW ALL 3 SHEETS
Receipt # -1 -I Z Staff: cl I-P
PARCEL INFORMATI N
Map Parcel: Existing Zoning C
Tax and
Parcel Owner:��j, f Sp yty� �,:�2 �k (,��(,t�0 _P I, o t v\\
Parcel Address: City State \)P\ Zip c?a`i�
(include suite or floor) 75b t U t
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : �� a City State Zip
Office Phone: &6V (u - Oy(�'� Cell # �-C4S ' l �U Fax # cj (o �i - o� 7 E -mail ��� �dW\e4z� -
APPLICANT INFO ION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ��y�, n yn G„ �,n, y(
Previous Business on this site ? C w �-VLt
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: - 7, 4 A "n �0'4
*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. nave read the conditions of approval, and I understand them, and that I wi 1 abide by them.
Un C\
Signature Printed Lau- r, - �--c -� ---CPO
AO L INFORMA ON
[ 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 `[ Z1 tVq
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/
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /IQ�
Will 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 one that applies
Is parcel on private well or ublic water?
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app C-blic
Is parcel on septic or p
Y/N
Will you be puttin up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /QN,
Wil be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 11
� N � -�
rmitted as:
Under Section: , f�,?.
Supplementary regulatig4s section:
Parking formul�l
Required spaces:
Y/N
Violations:
Y /
If s ist:
Proff s:
Y / r/ 'I-
If so, ist:
Vari ce:
Y�
If so, Niist:
SP's.
If SO (T
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3