HomeMy WebLinkAboutCLE200900121 ApplicationApplication for Zoning Clearance
CLE # -2M - /
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Zoning Clearance = $35
OFFICE USIR ONLY
Check # G1q e`7K Date:
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PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION PL A N J7 r✓V0Lb` C- Al XY
Tax Map and Parcel: % /,'Ietzo 79 /-lJ2d,67� 1�� Existing Zoning 04 1 X?GC p CxrkfkT
Parcel Owner: (mil 10A) ' ✓R�%G
Parcel Address: /'�' _D City Zip 22- �
(include suite or floor)_
PRIMARY CONTACT ' n , � �y5
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Who should we call /write concerning this project.
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Address: 251-7 �r�G G�/3�� City da1q_-ZV611 r6 State V l4 Zip � 31
Office Phone: �l� ✓' 311 # Fax # E -mail JQDSS.i��UfdN��D�
�aHa�- mom
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: AD0AAIMP 1L rs C-4 ;R1A6 Cj57A.11,C-RS , :T_74AE�_ .
Business /nY1 An J�9 G�/1 -sue
site
Previous on this site—�'S�.
Describe 5 ila5 bl o u� g spaces, s, number of
e e the proposed business
information I ! _D�.S A llp/4G
vehicles, and any additional that you can provide:
-7 96_671%Ai"U /vD / 5 &J-<CS A 6,4,elxk/ 1p in s AaslN S 12z u l vO EM
5. m- 0 -3 7/b 1ZA-'l G S QA 0,49715 S�
*This Clear nce will only be valid on the parcel for w ich it is a proved. If you change, ntensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or ave 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 nowledge. I h read the conditions of approval, an I understand t d that I will abide by them.
Signature Printed
AP OVAL 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 Date I la 1 i
Zoning Official Date 03,7/ Dq
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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1411 �3
Intake to complete the following: I Reviewer to complete the following:
Is /rNj,
Is usUYLI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /&Wil e 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
Square footage of Use:
Permitted as: 644 C,-e_
Under Section: �_6. 2
Supplementary regulations section:
A
Parking formula:
Required spa ^sr L
Y/N
Items to be verified in the field:
Is parcel on septic or public sewer?
Will you be putting up anew sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
Y /
Will e be any new construction or renovations?
If so, obtain tbe 1 4per Permit.
Permit # 'VA
J(00 _
7,nninu to emmnlete the fnllnwinu:
Notes:
Date:
Viol ions:
Y/�
Ifs ist:
Proff s:
Y/
If so, st:
Vari e:
Y/N
If so, st:
SP'
Y N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3