HomeMy WebLinkAboutCLE200900126 Legacy Document 2012-09-10CAN �
Application for Zon'ng Clearance_
CLE #
� �RGIN�P
Clearance =
OFFICE USE ONLY
Check # jG% Date:
oning $35
PLEASE VIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
V
L
Tax Map and Parcel: (ei, I Existing Zoning v
Parcel Owner: 11 0. � � [� t.� J ffla -, �ej f 1 �r.VVt.T , LLC
Parcel Address: 1 �. e,- �Lrn�.r L.� r _ City CInIU4i-eSvAU State V & Zip 5
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address C114 City + rc- State V la Zip 22-q (e
(f3�)
Office Phone: (y3l1) SVq-- ell # q(,1,- °7 `E ZS' Fax# E -mail drwe115dcc�g��t.1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name =AP New business
Business Name /Type: Za-V e- CLra, r-f,. c4 \c-
Previous Business on this site!, S'Co o-1- S 0 7grs -r,
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: V5-f-- o2�znyal�vs C�+�s3n; n /'*r+ -
0
&VA "['3 i� 7=30 (off+ a- FMS I c.rf 4 wle .. pc- rlc.Ac s Pkce.s `j'- 10 cri7 trek «Lc.c -on t U
*This Cfear1mce wi n y 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 ' �j Printed 'P Ja c 4k/15 J
r-
APPR,0VAL 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
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:
Is/
Is us au, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil ,Pe 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 pu lic wat r?
If private well, provide Health qa , ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl. e
Is parcel on septic or ublic sewer?
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 proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the //following: _
Square footage of Use:
0 ermitted as:
Under Section: 7.
Supplementary regulations section:
/(,-, X
Parking formula:
Violations:
Y
If (Wtist:
Proff r :
Y L
If so, List:
Varilt ce:
Y/N
If so, List:
SP's:
&/N
f so, List:
9/ fd h
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3