HomeMy WebLinkAboutCLE200900062 Legacy Document 2012-08-29Application for. Zo�snin Clearance'
CLE# 2DQ'Z
pF AL
PLEASZoning Clearance = $35
REVIEW ALL 3 SHEETS
OFFICE USE ONgo LLII Q Q
Check # 5) Date: T ' 2U -o I
Receipt # �71/ ZZ Staff: J l��f�/'
PARCEL INFORMATION 1 �n
Tax Map and Parcel: q- / � Existing Zoning /' "/
Parcel Owner: FAIMF � ME tt'C'
Parcel Address: q0q PGA I Gl.�- City 014-40 ! UU State Zip 9- zq
(include suite or floor)
PRIMARY CONTACT 16/
Who should we call /write concerning this project? -D4 (700T
Address: V o q pp r- t o pu j L City C '111 L ll State VV4- / Zip 2� �
Office Phone: (q3q gr21 Z Cell #43q bbl Fax #917 7610 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: V UMV��I `1 /p7buapo/vo 5i,,1- 00 L-
Previous Business on this site 06L" 1Ut9 1 SLIT U4156))
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:
*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 o knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Si nature �1� � Printed �iltIVIn- 7' 111001,4 -1..
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APPROVAL INFORMATION
[/] 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
Other Official Date
County of Albemarle Department of t_:ommunity fuevempmenL
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 Lei, Is HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /1
Wil e be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin ntil 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 Heath Department form.
Zoning review can not begi until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or publi sewer?
Y/N
Will you be putting up a ne
Sign permit.
Permit #
Y/N
Will there be any new i
If so, obtain the proper
Permit # A a—
sign of any kind? If so, obtain proper
or renovations?
Av
Reviewer to complete the following:
Square footage of Use: �� D
�ermitted as:
Under Section: I rl "—' Cob
Supplementary regulations section:
/A
Parking formula:
Ill R
Required spaces: I i1 VA— I
s 1O l ��
Y/N
Items to be verified in the field:
Inspector
Notes:
Date:
uvaaaaa
Vio i s:
Y/
If so, List:
offers:
Y/N
so, List:
VarQanie:
Y/
If st:
� s:
/N
f so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3