HomeMy WebLinkAboutCLE200900085 Legacy Document 2012-08-31Application for Zoning Clearance
CLE # 'Z-D
PARCEL INFORMATION
Tax Map and Parcel: �I Existing Zoning
Parcel Owner: A I b ere,,j e
Parcel Address: a 7 QR P'6VV k a + V City Cra44 State Vi+ Zip --4q
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ZM IJelf / 1J I� y�/�%L�' V J eok?'a
Address: PQ �75 City acqz= State Zip
Office Phone: ("S 7A9-nS D!f Cell # Fax # 9$S- <3aP'-9y4 7 E -mail iAl U Q L 6 y r27; / i
I APPLICANT INFORMATION I
Business Name/Type:
Previous Business on this site
(�l L-,Piw
Describe the proposed business including use, number of employees,
vehiclpTs, and 4ny additional information that you can provide:
spaces, number
*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 r 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 th est of my know dge. I have read the conditions of approval, and understand them, and that I will abide by them.
C
Signature Printed Jul
compli
Ig V11MM s.,
Laic_
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
Is le in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will re be food preparation?
If so, ive applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
S.uare footage of Use: A
ermitted as:
Under Section:
Supplementary regulations section:
(QA
Circle the one that applies Parking formula: /
Is parcel on priva w JA
ell or public water? , C
If private well, provide-Fte6thDepartment form.
Zoning review can not begin unti we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies Items to be verified in the field:
Is parcel on septic or public se er?
Y/N
Will you be putting up
Sign permit. /
Permit #
Y/N
Will there be any new
If so, obtain the proper
Permit #
Zoning to complete the
sign of any kind? If so, obtain proper
or renovations?
Inspector •,
Notes:
Date:
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