HomeMy WebLinkAboutCLE200900096 Legacy Document 2012-08-31Application for Zoning Clearance
CLE # %i� qu
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Zoning =
OFFICE USE ONLY Q /
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Clearance $35
Check # tl Date: (J�
PLEA REVIEW ALL 3 SHEETS
Receipt# "753ia?- Staff: P(.2',rf'o
PARCEL INFORMATION , ( J 0�/T /j __�h
Tax Map Parcel: l
and Existing Zoning
Parcel Owner: r ifi f2'J) 6tiW
Parcel Address: 707 �,7= 1- vC�L,2t ityF City State ui"3r Zip "i0
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1_4+GyZ,6A COPPOLA
Address: 3O1 DW6� Oft City State VA- Zip '9a z)!
Office Phone: �E3 6114 -1 Cell # �i`1t� -Ob �1 Fax # E -mail -4 CrSCC . 00, CD✓-7
APPLICANT INFORMATION
Check any that,apply:' ' Change of ownership Change of use Change of name New business
Business Name /Type: A'_�D brims C"- t.c_[3
Previous Business on this sate Sw, — &qzc ' iGNN'S Cu, l
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: S ,,�_ F,, r/ 2L4 rJ 0 r J7 U4_Y I k�•&-r
We 'A-i 744 C A,,& CoL-D atLl
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*This 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
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_havee read the conditions of approval, and I understand them, and that I will abide by them.
Signature �JU`a°i�_ �y� `�� Printed
APPROVAL INFORMATION
[ - "]Approved as proposed [J pproved 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 'te om lies with the site gjlanas of this d te.
�
Notes: � d9 0_ z
Building Official Date 4 _C)
Zoning Official Date (7 1 X9,0 `►
Other Official A o q Date Cam! ! Z.6-1
County of Albemarle Department of Kommunity 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 use LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will tre 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 Ail 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 si of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new co struction or renovations?
If so, obtain the proper ermit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 6
Y/N
ermitted as: �'Il/!2 .� Q/�i°/4trt
Under Section: �ile -41,
Supplementary regulations secti n:
Parking formula:
Required spaces: c
Y/N
Items to be verified in the field:
Violati s:
Y/
If so is :
Proffers:
Y/
If s , L' t:
Vari ce:
Ifs ist:
IfIfs
SP's:
Y
If � ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3