HomeMy WebLinkAboutCLE200900082 Legacy Document 2012-08-31Application for Zoning Clearance_°
CLE # G��� pTf
Zoning Clearance = $35
OFFICE USE ONLY .D�
Ckeeir# Ci Z Date:
Receipt # -7 i b MUf Qi(
PLEA REVIEW ALL 3 SHEETS
fi J 0 Staff:
PARCEL INFORMATION n
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Tax Map and Parcel: 561 p� � L Existing Zoning
/00 11
Parcel Owner:
Parcel Address: qqo i6 Ivy Cornny✓]s City (_1, ,r1o:U-e$viJJtate yA- Zip '-20-00"
(include suite or floor)
PRIMARY CONTACT
Robert- 1:5 Ity
Who should we call/write concerning this project?
Address: 5 35 . aO'MeSfown Kd City Gro7 -e- I� State VA- Zip a6_03a
Office Phone: 7"6D WCell # 5 c.M a Fax # h E -mail bGlf� . I S IEV6� C, ►M1'1Al •Col'►'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: i ftww' e T ��Y
Previous Business on this site
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: >°
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*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 t e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature i Printed R 6 e r4- F, 1 S (L° V, —rrF
OVAL FORMATION
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 cgqmplies withpie site plan as of this date.
Notes: 8A—KA AA e-0— &4- `Z,f a—t-6c D
Building Official ' Date
Zoning Official' Date l ®l S� 01
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:
Is /lN�
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will 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 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
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
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:
footage of Use: 7 U V
)Y / N /� � at/j
/
Permitted as: 11"F►'I 1
Under Section: t
Supplementary regulations section:
h,1
Parking formu��z 6 0,►A
Required spaces: a
Y/N J
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so Lis
�I
offers:
/N
so, Lis
!2
3 V SYA
Variance:
Y/N
If so, List:
If so, J , r�V
(7T 'e�
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3