HomeMy WebLinkAboutCLE200900086 Legacy Document 2012-08-31Application for Zoni Clearance
CLE # 2.y(xi - 0u ng
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PARCEL INFORMATION
Tax Map and Parcel: 1 -" i
i Existing Zoning
Parcel Owner: al, &S A) tf C-T- Oa &g4S_- a lllrA
Parcel Address: 55'0 Aurj- A&L,,, A Cfik City State VA Zip OA93
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ITlp& 1 ZZ44 I & 1 aW14L12_ Vieb1.0 t&
Address : PQ I,trV, t,75 City A INC State V�r zip '.20
Office Phone: &Cj-) aA9- 0S09 Cell # W l- $4G-.5 7S Fax # 30419� E -mail j N M 1 N
I APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts,
vehicles, and any additional information that you can provide: V _f sj7w
spaces, number of
*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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate tVhe st of my knowledge. I have read the conditions of approval, and I understand ahem, and that I will abide by them.
Signature e Printed &qUy
Zoning Official f
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 us I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will 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
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:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
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