HomeMy WebLinkAboutCLE200900114 Legacy Document 2012-09-10r�
- -- _ - _ - -- Application fog Zo onin
CLE # 0 q '' /�
Zoning Clearance = $35
3 SHEETS
OFFICE USE
Check # Pfikyq
J
Receipt # 5 l Staff: 2 071"
PLEAS REVIEW ALL
PARCEL INFORMATION
Old
Tax Map and Parcel: ( L Existing Zoning
W,
(h7 Jf);
Parcel Owner: U�N j�(JIL� OJ f
Parcel Address: D U (i M tl' City C'U l u 6/ State y fiL' Zip
1
(include suite or floor)
PRIMARY CONTACT , [
e l l U
o `` ' S�A
Who should we call /write concerning this project? I� Iy
Address: I N� I DO( I-al f (wri U l 4— City ^ � y)o n d State Vi ne, 1 I Q Zip
(��
Office Phone: L_) Cell # �011-11.1)4l) ax AY M0 0{ I 4 E -mail b li��Q�`'� ^I�ilal .��F�i'(A�`lu` ��fll�(I�V�i
APPLICANT INFO TION
Check any that apply: V Change of ownership Change of use Change of name New business
�� 1�7(�� �ii�� �'.�� �i� 5: �._iL�� ��Y Rental
Business Name/Type:
Av t ]� /� /
S I� l',. ����✓
Previous Business on this site -i��l /�
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and ny additional information4hat you can provide:
7
*This Clearance will only be 4alid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify hat I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac to to the best of wledge. I have read the conditions of approva I understand thKvimfixi m, and that I will abide by them.
tnd
Signature Printed U y a
APPROVAL INFORMATION
Denied
[� ] Approved as proposed ]/Approved with conditions [ ]
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ This sites e complies xvitb th i$ te plan as of this date.
Notes: x�x� ' l/" �.�JGI/i2 Si D!') �vf� �lN �i/t'Ld �/�t -� l��/'✓�2�2�
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Building Official �- Dated `�•Q
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
L-/
Intake to complete the following:
Y /N'
Is use n' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /f N)
Will ere 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 until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
i
I
I
Reviewer to complete the following:
Square footage of Use:
J /N
Permitted as: Go%_FurWU/VL
t Gil
Under Section:
I
Supplementary regula ions section:_
Parking form 1 :a �
Required space
Y/N I
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
04 44-- - Inspector;
Y / Notes:
Will re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Date:
Vio ons:
Y /I"
If so, List:
Pro s:
Y
If so, List:
Var ce:
Y/N
If so;'List:
S
Y
If so, List:
Clearances:
rte—
SDP's
Revised 04/28/08 Page 3 of 3