HomeMy WebLinkAboutCLE200900116 Legacy Document 2012-09-10Application for Zoning Clearance
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CLE # ��q - Mr
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21-oning
OFFICE USE ONLY
Check # % % 5-, Date:
Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 Staff: 2 77 V
PARCEL INFORMATIO
Parcel: If 7 Existing Zoning_ ?_A
Tax Map and •
Parcel Owner: U,;i %fc,5 le v, C IC
Parcel Address: ?1ao %20aci1 City AV GorrA State V/1 Zi pZ
(include suite or floor) -
PRIMARY CONTACTZ f I
Who should we call /writeconcerning this project. v o, -jrl 15f,
Address : ,,? o6 , n
(o t -:,t 1,7-,PJ /L7"/ / (+' • City State �� Zip 2 297y-
Office Phone: 75' Y/ rZ Cell # Z z `f-r1C,6 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change Change of use Change of name New business
ffof__ownership �+
Business Name /Type:
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:
*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, and Ipunderstand them, and that I will abide by them.
Signature Printed ;`y 4� A/ fir/` i'J-,
APPROVAL INFORMATION
[ ] 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 a "'�'`"\ 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 /�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department forma
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use:
" /N
ermitted as:
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
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 Required spaces:
Dept. FAX DATE
Circle the one that applies 17" f
Is parcel on septic or public sewer?
7/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit. / q
Permit #
Y /
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit # � �1� /
Zoning to complete the following:
Violations:
Y�
If so, List:
Proff s:
Y /N
If so, ist:
Variance:
Y /6
If so, List:
SP's:
/ N
so, List:
Clearances:
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SDP's
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Revised 04/28/08 Page 3 of 3