HomeMy WebLinkAboutCLE200900118 Legacy Document 2012-09-10Application for Zonin Clearance
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CLE # — //
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Zoning Clearance = $35
OFFICE USE O LY
Check # , �u Date: 70 v
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 5-7, / Staff: 4 /r..L/
PARCEL INFORMATION
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Tax Map and Parcel: Existing ZoninIZ J
Parcel Owner: H A -rC L
Parcel Address:.) l % A Pt- City C 6A-4vt l e,5 Vt148tate V A Zip 9
_ - (include suite or floor)
PRIMARY CONTACT l
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Who should we call /write concerning this project? y/M d��^ i
Address : q ®d A L_'r1+1g PN t 9 City C �J �'�a`� 7- e�v�t�State V A Zip
Office Phone:_ Cell #,q 'X5 Sz7aaFax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: r(� i'<A11 11 D%31A W b -r-e LG fii4 Gv
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide s d v4� i'�19 io 'die a .l�1�914 4 /_ S
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*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 I understand them, and that I will abide by them.
Signature � Printed A4 A L� 114 w
ldctd Z
APPROVAL INFORMATION
Approved
[ V as proposed [ ] Approved with conditions [ ] Denied
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[ ] 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 g "�
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
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- - Intake to complete the following:.. _ __ _ --I Reviewer to
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Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Ylf/
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
Square footage of Use: / g9 o
Yom! it fi�rr}}
Permitted as:
Under Section:
Supplementary regulatio s section:
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Circle the one that applies Parking fo la: (tip
Is parcel on private well o blic water? 1 /o�s0 y
If private well, provide Healt ent form. I
Zoning review can not begin until we receive approval from Health- Required spaces:
Dept. FAX DATE i
Y/N
Circle the one that applies Items to be verified in t e field:
Is parcel on septic or public sewer? () ly til/ j, at ✓
Y/N -
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # - Inspector: Date:
Y /
Will Abe any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnlPtP 1-ha fnllnwina-
Viol ns:
Y/ ,
If so, List:
Proffers:
Y/
Ifs , ist:
Vari ce:
Y/
If so, ist:
's:
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3