HomeMy WebLinkAboutCLE200900059 ApplicationApplication for Zonin Clearance
CLE # 2 DUq' 6
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,Zoning Clearance = $35
OFFICE USE ONLY
Check # 649 // Date: f4. l u .v 9
PLEASE REVIEW ALL 3 SHEETS
Receipt # JUe -7 3 Staff: J (mil
PARCEL INFORMATIO C
`A4 13 -,2 F�-
Tax Map and Parcel: Existing Zoning
Parcel Address: %iT/����yyl7 —��i City (%LG�= State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? iSt' A`C kR zo C,Ak -3
Address: G`�` �ar�a+e�- ����� -. City State V tN,- Zip-Z'Z0
Office Pltone: Cell #'2�7_^ `Z'Z`3 Fax # E -mail �c2i�s� >��!►°'
APPLICANT INFO ION -
Check any that apply: Change of ownership Change of use Change of name 0—` -New business
Business Name /Type: A%n or i -za,
Previous Business this
on site
Describe the proposed business including use, number of employe s number of shif s, available parki g spaces, number of
fit", P 4�CAckerZ5,
vehicles, and any additional information that you can provide: l tGG �`
M4- wee- LmA5
*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 inforination provided
is true and accurate to the best of my knowledQ . I 'cad the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Q G
APPROVAL IN TION
[ ] Approved as proposed X] 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 s to ompliqp with the site plan q of this date.
Notes: \�� 6L-
Building Official Date -j `� z,
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
1. Zb
I-
Intakee to complete the following:
Is /�N /
Is us 1 LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /V
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 pu 1 c ter?
If private well, provide Health nent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or pi AL�er?
YG /N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Will there be auy new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmnlete the fnllowinu:
Reviewer to complete the following:
Square footage of Use: ' -;�
P�ii tted as: C&t4 -cQ 1 —t>A ,W ►� t� SGVI�d
Under Section: 25' � • I
Supplementary regulations section
Parking fo •mula:
+ I I�erevn� .
Required spaces:
-�
Y / N (s &47CQ
s' to be verified in the field:
Inspector : Date:
W
Viol o s:
Y/ Ifs ist:
�S/O, Est:
Vari e:
Y /
If so, ist:
SP'A'ist: •
If If
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3