HomeMy WebLinkAboutCLE200900108 Legacy Document 2012-09-10Application for Zoning Clearance
CLE# ZbQg -io'b
I*-
Zoning Clearance = $35
OFFICE USE ONLY
Check # d Date: �tQ �'�
PLEA REVIEW ALL 3 SHEETS
Receipt # -75 !'O Staff:
PARCEL INFORMATION --
Tax Map and Parcel: (� Existing Zoning
Owner: a v50V ii PO 6L 0'
Parcel
'
Parcel Address ' ( _ A t City _ LOILState- V 1'a'` Zip 2 2(?�
-- - (include suite or floor)- -- -
PRIMARY CONTACT
/write ?F- /LYL`/
Who should we call concerning this project
Address City State Zip
:
Office Phone: X13 12 -13 -0 Y %Cell y 3q) 2'/'L -0K &(Fax # E -mail
APPLICANT INFORMATION
Check any that apply: ✓ Change of ownership Change of use Change of name New business
Business Name /Type: yAc-yvK .5`AL,f5_ d Sk/LV/ �= SAU ,,S l&,f-,PQIA-
Previous Business on this site <-a y,,,r A f' /3D ✓)"..
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 PAVC - )5'1 4 -1r-f y AAA Jn.
*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 I have read the conditions of approval, and I understand them, and that I will abide by them.
nnknowledge.
Signatures Y� Printed
APPROVAL INFORMATION
,[ j 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:
Y /\ N I'
Is use In °LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y�/
Will- 11-ere be food preparation?
If so, give applicant a Health Department form. _ - - --
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:_..
Square footage of Use: I qoy
N ! �/
ermitted as:
Under Section: �� •�—•
Supplementary regulations section:
Circle the one that applies Parking formula: , II'1
Is parcel on private well o u lic ter? ►� �`'`! C�"t d i J1`�CY�
If private well, provide Health�ment form.
-- - Zoning review cannot begin until we receive approval from Health- Required spaces:_
Dept. FAX DATE
Y/
Circle the one that applie
Is parcel on septic orpJ1b is se er?
Y /(N)
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit -# -- - -- -- - - -- - - - - - - - -- - - --
Y /t0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Ite be verified in the field:
Inspector : Date:
Notes:
Viol tions:
Y /UN
If so, List:
`Prof?eers:
Y/
If so, ist:
Varian e:
Y
If so, ist:
(Y/
S 's:
N
If so, List: cf)
Clearances:
SDP's
CS(, 1L
Revised 04/28/08 Page 3 of 3