HomeMy WebLinkAboutCLE200900092 Legacy Document 2012-08-31Application for Zoning Clearance
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CLE # '". T7�
OFFICE USEQ� U 2 Date: 6'0.1
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,Zoning Clearance = $35
Check —
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: 6/ 09-w
PARCEL INFORMATION
Tax Map and Parcel: CSC 66 Existing Zoning e e.
Parcel Owner: /971-7 Y 1;1g,,9,P7-;, .J L L t' ,
1665 .
Parcel Address: SE�lin/OC E i 1E /GYI. ,.CCity Gy/.Fl zyr _s ✓ius State Vlq- Zips D /
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
/ B85 , 1 1'
Address L-�iA0 _—ww �Citye11eW4ATT&SVictE State Zipa�D/
, F3tl - I/Ss/-
Office Phone: (#5()>_�o •.Q 0zl Cell # 416S -D33.) Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership ✓ Change of use Change of name ✓ New business
Business Name /Type: O- CVPgez or723✓iccE Ld Ll— Z) JO t Ui/LG /;Sh"13 Ie(��LjZ/
Previous Business on this site ,f2lS�� /tJs�ES
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: OFFICE e D< .C��7t�
,-,g iWae71W,,,.&',V Vr&,FWP.-.&w_ & ; r A668LIS
*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signattu Printed Zi.✓a,7 L • i�ff�uJ� LL
AP OVAL INFORMATION
[,00 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 �C/ Date i 1 yo
v
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/�Nj
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /bl
Will there 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 p 11� is wafer?
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 a 1* s.��
Is parcel on septic or pubic - server?
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:
M
Square footage of Use: I
V/ N
Permitted as: Y a �SuJ D r'89 I /iC;;�
Under Section: Z I `�' s�
Supplementary regulations section:
Parking formula: v A
Required spaces: J
Y /(Iq
Iterr to be verified in the field:
Inspector :
Notes:
Date:
Violations:
/N
T f so, List:
Proffers:
Y/
If so, rst:
Variance:
Y /�I
Ifs ,,List:
SP's:
Y / I)
If so, List:
Clearances: tt
SDP's
Revised 04/28/08 Page 3 of 3