HomeMy WebLinkAboutCLE200900088 Legacy Document 2012-08-31Application for Zoninhr, Clearance_
CLE # Z O�
�lRCIN�P
Zoning ClearancQ.,= $35
OFFICE USE ONLY
Check # I (q Date:
PLEA E nEVIEW ALL3 SHEETS
Receipt # 5'L Staff:
PARCEL INFORMATION
—
Tax Map and Parcel: Nj� U e) — 00 0-00 Existing Zoning
Parcel Owner: 6 C2, _!"A
Parcel Address: k1rkwyk,r L)d City Ckrik Wk State �� Zip Z2�o1
�
(include suite o'r,floor)
PRIMARY CONTACT
Who should we call /write concerning this project? SAS, li 1 fc1T�C
Address: Z�JS oSwOCk 1fhGe_._ City JiN� State I� Zip lUl
�V
,
Office Phone: ftqi� (crC(a i Cell # 53 i ;L4 35 Fax # -6132– E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership ✓ Change of use Change of name New business
Business Name/Type: , aftla iC'i 6t(J6,"N-
1�1
o
Previous Business on this site � �u.�6�t�.�
tt
%`� 5�'c�l' ivW�•n�- ".wi " uGccat2•y.eQc� rvt$A sit"'
Describe the proposed business including use, number of employees`,: bar of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: t
S
*This learan wit 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 accur to the bes f nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Svc Q , A LcrV cuff—=
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 plan 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:
41)n Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YF,give Wi re be food preparation?
Ifs 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 ublic w ter?
If private well, provide Heal rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic se er?
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 y new construction or renovations?
If so, obtain�ie proper Permit.
Permit #
7.,,. :.... +.. .n.G...in +n +ho fnllmarintr-
Reviewer to complete the following:
Square footage of Use: 1 ,3q y
P rmitted as:
Under Section: li� • 2•
Supplementary regulations section:
Parking formulr: D
Required spaces:
Y/N
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y/N
If so—,List:
Proffe
Y/
If s is
Vap�lce:
Y (/ v
If so, List:
SP's
Y /
If so st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3