HomeMy WebLinkAboutCLE200900060 Legacy Document 2012-08-29V
Application for Zonin Clearance
CLE # (,�I -
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�IRGIN�P
QTZoning Clearance = $35
OFFICE USE NLY
Check # �i��N Date: el g
PLEASE REVIEW ALL 3 SHEETS
Receipt # 1 N -15- Staff:
PARCEL INFORMATION Q �
Tax Map and Parcel: S-/ V le-) Existing Zoning 1 ��
1
Parcel Owner: ( i'V I ut, L; 61(, 1 1 n, (_ \/,C
Parcel Address: AS-( I V V 2d. City &KO-4 I 4 SY I I',tState V09 Zip �W
(include suite or floor)
PRIMARY CONTACT — r
Who should we call /write concerning this project? S l p r
a�-5'Aeq
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Address: / II / 6 IgI ,1 1;. ,, �G1 City e'IYc J State lf' 1 4 Zip ZZ
Office Phone) 9 6. Z9 I.; Cell # Fax # E -mail
IhIm ( Sc. lJ- 3� 7 -Z5 6,
APPLICANT INFOBNXTION
Check any that apply: V Change of ownership Change of use Change of name New business
Business Name/Type: A to % haD 0.4-) 'p _
Previous Business on this site y e 0--j-) V
r
Describe the proposed business including use, number of employees, number of shifts, available arkin spaces, n tuber of
vehicles, and any additional information that you can provide:,f} -tom. TU iepG. r- G-t,o S�j
i
*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 accurat toI the best of my knowled e. I have ead the conditions of approval, and I understand them, and that I will abide by them.
Signature V� r� Printed
APPROVAL INFOAMATION
[ ] 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 4
Zoning Official Date 4441
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
7
Intake to complete the following:
Is/
Is US &I, HI or PD1P zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y f
Wi e 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 public 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 or public sewer?
Y /
Wil G be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / CN�
Will t e 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:
i i litted as: fA rLl� U40-
Under Section: 24 •z . � 1
Supplementary regulations sec ion:
by 'c'
Parking formula: �
Required Required spaces:
Y/N /
Items to be verified in the field:
TIN ons:
st:
Proffers:
Y/
If
Var'a e:
Y L�
If ist:
SP's:
Y /
Ifs 'st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3