HomeMy WebLinkAboutCLE200900068 Legacy Document 2012-08-30Application for onin Clearance
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CLE # —
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Zoning Clearance = $35
OFFICE USE ONLY 5'6 D9
Check # Ii 5 Date:
PLEA REVIEW ALL 3 SHEETS
Receipt #-74VIZ6. Staff: _ j 2� ft
PARCEL INFORMATION
W .. (OKA �Existing
Tax Map and Parcel: Zoning
Parcel Owner: 106 10A 1 'k 46a"110 1i0*&n "M
Parcel Address: �J VytYyy4Pt,•ih Ty-. Cit y 1Vt�OU�%C fVY� E State M Zip ZZaO1
(include suite or floor)
PRIMARY CONTACT j ,
sch 0 t�
Who should we call /write concerning this project9 j1/ iel a 6
Address: '2320 (nmm t,v�lwTPi t �r. City r ha rl 11 Q State,/ Zip "22190
Office Phone: '1(� 823 — W'5 cell # aqo : yy % - '0731Fax # E -mail X 4IWA 1 I tCnrv'�
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
/^ (_Change
Business Name /Type: l,� 1C���Q(��1 - ,L°'
Previous Business on this site
Describe the proposed business including use, number of employees, number of shift, available parking spac; umber of
vehicles, and any additional information that you can provide: �tC S � 0. 0 -�l'
`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 th n or�have the owner's permission to use the space indicated on this application. I also certify that the information provided
I I by them.
is true and accur td e to e best of n>4162edge. I have read the conditions of approval, and understand them, and that will abide
Signatur : ` Printed
(H iL yV9
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 plap as of this date.
Notes:
Building Official Date
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
Intake to complete the following:
Y / -Nj
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil re 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 ublic 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 /NN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will there 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: -'-/02
N �pp��,,�
.itted as: Ace--
--
Under Section: �4'L1, 1
Supplementary regulat' ns section:
Parking formula:
t / 1-15 ►A
Required spaces:
Y/N
Items to be verified in the field:
Inspector :
Notes:
Date:
Viol 'ons:
N
s4 ist:
Y
Pr Fist:
If
Variance:
Y/
If so, i
SP'
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3