HomeMy WebLinkAboutCLE200900077 Legacy Document 2012-08-30Application for Zonin Clearance
CLE # -' 7
�l1N;IC11P
[Zoning
OFFICE USE ONLY
Check # Date:
Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7s lUC2�' Staff: /
PARCEL INFORMATION
Tax Map and Pa��rjcel: Ot W000- OA 00-2, 00 Existing Zoning l
Parcel Owner: KEU 1AJ CAP—S00
Parcel Addressj i qi SemmomE If—L City ChA,?t0g V• 1l, State VA Zip 02 ,70
(include suite or floor)
PRIMARY CONTACT
INJ WOOL
Who should we call /write concerning this project?
Address :ISO MeADa0�!,eCj0G City geeN(ll State Vii . Zip
Office Phone: (/ *j q,2 2 ,?1 & Cell # So1>► e Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: R c /��a��U �QyGS�sEASUN5 (' (4406e, I-Lc
Previous Business on this site 'g15SA U btd i.E4_ 41 P ,
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: i S�h(i= OF C IASS C V i(2fw)(A 9G*li
Er.Pp-yperS FQVM !,- 6 -0q 1111,s-V `7- a6 _0q 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 accurate to best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Si gn ature �rrrn�"' Printed f'IU
APPROVAL INFORMATION
[I ] Approved as proposed [PI 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 o�m�pjies with the site plan s of this date.
Ncootes: fiu : r014 a�iA�P.•'yF' �ar7 Gi, �0.�'9- 'r ✓U>'iti I��i1N.
rr
w R -100
Building Official Date S
Zoning Official Date 6 (�
r
Other Official Nyo( 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 / �1'
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will t 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 /N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit
Permit# '6C// LI-
Will Cie be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
/ N S e l�
ermitted as: �1 i�/�"'� ��� Z D
Under Section:
Supplementary regulati ns section:
iN� CL
Parking formula: I
Required space�r4lcllb )
Y/N '
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3