HomeMy WebLinkAboutCLE200900063 ApplicationApplication for Zoning Clearance
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CLE # 7
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Zoning Clearance = $35
OFFICE USE ONL
Check # Z11 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7g4T0 Z Staff: d c/�Y. UZI
PARCEL INFORMATION
5 U��'� C
Tax Map and Parcel: Existing Zoning
Parcel Owner: Adff/tv Adp ml yi # PfiD pKi rlo a (!-
JU /ic l00
Parcel Address: 1015 Hc/fi IICQCkOCT G /RCCG City Cf?D z-Ei State VA Zlp ZZ%3Z .
(include suite or floor) OG D TRA /` i 0U./iA/ G'Ey 7-C, t?
PRIMARY CONTACT
J) 0 Mew/ C 0 "9 U R/A
Who should we call /write concerning this project?
Address : �J& (-Iecc itloo -h Ji1frotl <Q . City 6171 oyyloo b State M Zip,?? 9 3
Office Phone: cW 160-240 Cell # 43/) W-1 0 � Fax # / E -mail Jo 0/7 (- 17, -7 /L. e- lily
s-4 o - l Y6 -607
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name -New business
/
Business Name /Type: Ita Chico- L L C
Previous Business on this site Aor t& Q U7 L� /�✓ fr
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: .3 ElmoYEcs, /5,9/Fr P.�PKiN� OCd ?nA /C Tou'ry CCN %c R,
SCrVI FOO& 00J74Y 4fPc r1 e61r1, W /NC ,4kA d3CE21'_
*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 be t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature —� . J 1 Printed -�JOfrE/v/ C0 -)t,4 UK/,"v
APPROVAL INFORMATION
r Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 Y ,3
Zoning Official Date CA-Z/ 12-01 0
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:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 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 it N
ill you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y /
Wil be any new construction or renovations?
If so, obtain e_proper e it `3 6 G
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
emitted as: (e J4 L 21 1 L'i
Under Section: r=a � (V
Supplementary regulation $ section:
Parking formula:
Required spaces: i V. �l�'A
Y / N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/n
so, ist:
offers:
VY /NIf
so, List:
Vari ce:
Y/
If so, List:
SP's:
�/N
so, List:
oln nS
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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