HomeMy WebLinkAboutCLE200900091 Legacy Document 2012-08-3105/25/2009 20:53 4349776735 PAGE 02
Application for Zoning Clearance
CLE a 2bm `? 0
®I,FILE us ® o. c .
zoning Clearance = $35 Cieck it pate:
]PLEASE REV EW ALL 3 SHEETS PACeipt # s Z l e Staff:
PARCEL INFORNIATIONT . c5�
Tax Maio and Parcel: Existing Zoning
Parcel Oernel : /� L i tvl P� �ir"E' e V►
Pared Address : yso Pay on4r•e -city ckot, I e< v' state Vd zip .2R DI
(laelade saitc or floor)
PRIMARY CONTACT
who should we can/writtee^cooncerning this ProJect'r�(� ��-�Q�
Address; c®l U ?TAY .4r. l / i ✓G city State �� �6p� ail
Office Phone: La Ceti a ;62-- 06 — Fax # �eiZ" -�% ` E- mail r -
Will
APPLICANT INFORMATION
c`eeik *.0 that m Chlmge Of awnecship Change of use change of name New business
Business NamelType:
� G A� 7r�4
Previous eaw ess on this site ��ierS
Doseribe the proposed business including use, number of employees, dauber of sk available parking spaced number of
vebk*s, and any addiflonal information that you can provide: °�gf
•111 Clearance will only be valid on the parcel for which it is approved Ifyou change, intensify or move the use to a new location, a new Zoning
Cle son a will be required
I blereby on ify tbal 1 own or have the owner's permission to use ft space inadiceted on this applicatim I also certify tbat the k&rm0dQn providod
is true and accmatn to die best of my knowledge I have Lead the conditions of apprevai, and I understand them, and that II Will abide by them.
Signature printed IG�G /4
4
APPROVAL INFORMATION Denied
[ A Approved as proposed L l Approved with conditions [ a
[ ] Backflow prevention device and/or curre tt test data trended for this site. C tact ACSA, 977-4511, x119.
[ ] No physical site inspection has been done for this cicaranCe. Therefore, it is not a deftnid on of compliance with the existing
site plan.
[ ]'Phis site complies wade the site plan as of this date.
Notes:
Building Official ' Date
Zoning Official Date
Other Official Date
CoRltr of Albemarle Depsrtmeat o(Commusity Fax: 9724126
401 loscta>xre road c>barlonesriiie, VA zz90� Voice: (43-4) 29&502 ' ( Re sed o429/09 Page 2 of 3
05/25/2009 20:53 4349778735
Iotaki to complete the following:
Y /
[s V us GI, I or PDIP aoorAing'1 so, give applicant a Certified
Engineer's Report (CER) packet.
WU
Will Lre be food preparation?
if so, gave applicant a .Heath Departruent form.
Zoning review can not begun until we receive approval f wn Health
Dept VAX DATE
Circle the out that applies
Is parcel on private well or r
if private well, provide Heath blie wa
t form.
Zoning review can not begin until we receive approval fMM Hmhh
Dept ]FAX DA'L'E
Circle the one that appl'
Is parcel on septic or
Y/N
Will you be putting up a new sign of any lsurd? If so, obtain proper
Sign permit.
Permit # _
X/N
Will there be any new constriction or renovations?
If so, obtain the proper Permit.
Permit #
zoninet to complete the foliowinw-
Rt-- er to complete the followi Ng:
Square footage of Use:
/N
ermittod as:
UxWer Section: %5, 2•
Supplementary regulations section:
Parking formula: I y ray 0 )(_ 16 v
J
Required spaces: :14
Y /`Nf
Items to be verified in the field:
Inspector • Date:
Notes:
PAGE 03
Viola ■a:
X 1
7f so, ast.•
Frva�cea:
X 1A
if ist:
Variance:
Y /(Nj
lfso, tst:
Y/N
If so, List: ,
SDP's
Clearances:
Revised 04/28/08 Page 3 of 3