HomeMy WebLinkAboutCLE201200184 Legacy Document 2012-08-31Application for Zoning Clearance
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❑ Zoning Clearance = $�SO. OD
OFFICE U NTLYC�
Check # Date: S'o�{)" 1a
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: d do I U O - D DO - b D Existing Zoning (2--1
Parcel Owner:_ A 61 V 1 l :r I -A 1..17 1 q
ParcelAddress: 8159,1 MMArL-V IVIE city CHDaL 71�"jVIU- (Mate XA zip 2Z9O�
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �� ��): _ A. .& L 1Zi g:C, rrT-
Address :mss 1 -rsyW LGH -$�M.A G City C 1rSVfI.(.6 State VA Zip ZZ 9a1
Office Phone:) Cell #s0 / -2V_W Fax# 973-01JZE -mail -SurcC,orilb Vatods.ro
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name /Type: S H V-f-W 1 N- kl l ALA A pA _�;
Previous Business on this site
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: 1M'I' SAIX5 Ll igto ilo ycES_
- S 4 1 r�T . 2- ?__ �FAtA/_1 ig l_� S 17AC,( -_� :A Ho C0 A.cXA e..l`l 1i1�1 -� 1
*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 ie owner's pennission to se the space indicated on this application. I also certify that the information provided
is true and accurat to the best y r o led e. I have re the conditions of apprdval, and I understand them, and that I will abide by them.
Signat _ Printed U�_ . 7y "0
PPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official e- Date
Zoning Official Date 2/ gdzz "�y
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, 10/13/09 Page 2 of 3
Intake to complete the following:
Y /C�—V,
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /V
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 public water
If private well, provide Hea epartment 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 lic sewe
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
)'// N
Wiill there be any new construction or renovations?
If so, obtain � the proper Permit.
Y�'1'
Permit# "PL 10 Ii79-
it 13 2012- - IS-OS -AC
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 41y%y _ / 6 1arA, �
Ye N
r mitted as:
Under Section:
Supplementary regulations section:
Parking formula: X �v
Required spaces: ?�
Y/N
Item o be verified in the field:
Inspector : Date:
Notes:
Violaj�i
Y /PN)
If so, ist:
Proffe s:
Y /
/(NJ
If so, ist:
Variance:
Y /'1
If so, List:
SP's:
Y /N6
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3