HomeMy WebLinkAboutCLE200900065 Legacy Document 2012-08-30Application for Zoning Clearance
CLE # D Q0 q 45
�IRCIN�P
Clearance = $35
OFFICE USE ON Y
Check # 'goo Date: 5 OGl
Zoning
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: io7"S
PARCEL INFORMATION
Tax Map and Parcel: NP I do 0000.13 ; 0K) Existing Zoning P
N
Parcel Owner: lJl/ �SoC -4 s
Parcel Address: s a) 1 w . 9GCity C%ll I (f State Zipc io
(include suite or floor)
PRIMARY CONTACT
Who should w all /write concerning this project? .~
Address : ` �J�i� -S �� City f 0) ! f State Zip o22-�D
Office Phone: `3. 4 5 Cell #�- �,Si(%,� Fax # E- mail '(��it�/p
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site X r�
Describe the proposed business including use, number of employees, number f shi�f ,..�a,vailable parking spaces, number of
vehicles, and any additional information that you can provide: v � &-"�
1 - 3D2(yo a - o2"oX'ZOZS
*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 pe 'ssion to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate t e best of my knowled . I have read the conditions of approval, and I understand them, and that will abide by them.
Signature / Printed L (S
APP INFORMATION
jf 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 G
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
N
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will t 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 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?
YY N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. _ C
Permit #�— 2 O� • J
Y
Wi ere be any new construction or renovations?
If so, obtain the proper Permit. /
Permit # ', / D 0 �— 0 7J
Zoning to comDlete the followine:
Reviewer to complete the
� /following:
Square footage of Use: y L � � 9-
/ N
Permitted as: �� >� ej1/ r
Under Section: dXM )!1/j! • A-4 A c �
Supplementary regulations section:
Parking formula:
; (, es'
Required spaces:
Y/
Item e verified in the field:
Inspector : Date:
Notes:
9 lations:
/N
If so, List: A )
Proffers:
Y/�
If so, ist:
Vari ce:
Y /—L
If so, ist:
SP's.
Y/6
If so, List:
Clearances: A f /
A / � �n� �/i� L1✓ 1 T
SDP's
Revised 04/28/08 Page 3 of 3