HomeMy WebLinkAboutCLE200900109 Legacy Document 2012-09-10l
Application for Zoning Clearance
CLE # 1"-71)0&1
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PARCEL INFORMATION
Tax Map and Parcel: (�
Parcel Owner: 'bac j,6j 7% -e(
Parcel Address:
(include suite or
-- lici
Existing Zonings 4
PRIMARY CONTACT ,
Who should we call /write concerning this project? /,& s'���4
Address : /&) ✓l A(y � ✓ACC % ✓ $hate i^ Zip —e5• 2/
Office Phone: f —Y 9 O -Cell # FA? 13-72ZJ E-mail
- --
APPLICANT INFORMATION
Business Name /Type: 1a Y O�l)
Previous Business on this site
Describe the proposed business including use, number of employees 3j Amber of shift ; avail If parking s ces, number of
vehicles„ and anv additional information that you can Dxovide: /, / ",4P�7Gf�'l Up .�ai . P-�'7 . � 464 ;>- &, 2/
*This Clearance will only be valid on the parcel f& which it is approved. If you change, intensify or mode the dse to a n- E4 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 to4he best y knowledge. I have read the conditions of approval, d I understand ahem, and that I will abide by them.
Signature
Z ��L Printed l�IG2 T�as!',
Date q
ng
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
P
1
— Intake to complete the following: Reviewer to complete the following. - - -
Y / Square footage of Use: N A
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. _Yj N
ermitted as: L41t J- 2 ye
Y /
Will there be food preparation? Under Section: aL (y} ce'l
- - If so, give applicant a Health Department form..-
Zoning review can not begin until we receive approval from Health - - Supplementary regulions section:
Dept. FAX DATE 010-
-
Circle the one that applies Parking formula:
Is parcel on private well or public water? 0
If private well, provide ealth Department form.
Zoning review can t begin until we receive approval from Health Required spaces: C j� �) - - - - - -- - -- -
Dept. FAX DA D 1 kC 1 �/V) -,
Y/N
Circle the one hat applies Items to be verified in the field:
Is parcel on s tic or public sewer?
Y/N
Will you be putting up a new sign o any kind? If so, obtain proper
Sign permit.
- - -- - - -- - -- - - - - -- - - - -- - - - -- Inspector: - -- - - - - -- - - -- Date: - -- - -- -- - --
Permit #
Y / N Notes:
Will there be any new const ction or renovations?
If so, obtain the proper Pe nit.
Permit #
Zoning to comDlete the following:
Violations:
Y/I
If so, kot.
Proffer
Y/
If so, .
Vari ce:
Y/N
If ' t:
SP's:
Y/
If s st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3