HomeMy WebLinkAboutCLE200900113 Legacy Document 2012-09-10A pp lication for Zonin g Clearance
CLE # A 00 -'//3
[Zoning Clearance = $35
OFFICE USE ONLY n
Check # 197 5 Date: ! -�
PLEASE REVIEW ALL 3 SHEETS
Receipt #-1= Staff:
PARCEL INFORMATION / r� / 1��
Tax Map and Parcel: %Toa X M Ala .SO Ayea I 1/0 Existing Zoning I7
'7-
Parcel Owner: I 1 ?�V/► t� SThi/1 yS ad Bite brl a ,1n yr -rA-r, L L C
Parcel Address: Yyo AAJroi toe '/QO City 6/'0 L;Le f State UA Zip U-?03
- _- (include suite or floor)
PRIMARY CONTACT
Nyid / ( /l�
f
Who should we call /write concerning this project? y Lge
Address: /Rz Vin%ryree^ Lune City CA#4&ty1-Ile State V4 Zip 22f03
Office Phone: tc LV,) Cell # YN-ff4 -7dt Fax # E -mail IN44eeri_.ddS LP -y*400•Co, ^
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name )e New business
/v/Change
Business Name /Type: GP4era1 '0P ,J�7i6 '" 'OAytd A. / Y6,9e, OLj Lc„
Previous Business on this site noft
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: WeA66( PtAd4e, �( pn.plOyees, / shiff,hlo.d .l, - F-
pwk-j siOFtas (2v± oSoe) fItd wig, b %c 9,4, SA 640,
*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,, the/m,,, and that I will abide by them.
�and,I /understand
Signature !/G./ (/� Printed I✓R✓tV A. / x4 e Jr.
A ROVAL 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 comglies 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
A 1
Intake to complete the following: - -- -
Y/O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /1l
Will there be food preparation?
If so, give applicant a Health Department form.- -
Zoning review can not begin until we receive approval from Healtl
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or uPepartment ater?
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o ublic wer?
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 pro er Permit.
Permit #
7nnina to emmnlPtP the fnllnwin¢-
Reviewer to complete/ the following:.
Square footage of Use:
dermitted as: o-A! ce,
Under Section:
Supplementary egulations section: -
CA-
Parking fo �ul�: f %
Required spaces: Gj► - - - - -
Y/N
Items to be verified in the field:
Inspector •,
Notes:
Date:
Viola 'ons:
Y/
If so ist:
Proffers:
Y
I s , ist:
Var nce:
Y
If so—, List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3