HomeMy WebLinkAboutCLE200900135 Legacy Document 2012-09-10C& KI C)
Application for Zoning Clearance
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CLE # G 000 — 0
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] -oning Clearance = $35
OFFICE USE ONLY /
Check # A 5 11 Date: `
PLEASE REVIEW ALL 3 SHEETS
Receipt ((21,35:_ Staff: %
PARCEL INFORMATION - - - -
Tax Map and Parcel: Existing Zoning
Parcel Owner:
f� (� _ j� ,
� � �i i `' City )V' State V A- Zip
Parcel Address:11-1 !.� � -e
(include suite or floor) - - - -
PRIMARY CONTACT
( -- -y ' U
Who should we call /write concerning this project.?
Address: P. 0 - 9 1 b City e State 4 Zip
0
Office Phone: Cell` Fax # 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: �/ E �� k) e T MJ 5
Previous Business on this site c- 0 1 )-i
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: e\ •"-,v Ij
S
*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 Pei: • fission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the_ of knowle e. lave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 64-5�6 t l_ ai L)/-,/"-., 9
APPROVAL/ INFORMATION
X]
[ ] Approved 4s proposed EV 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.
i
[ ] This site compli �jwith the sit plan as of this date.
Notes: I! �1 W l•Zf�
Building Official Date
Zoning Official X, 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 us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wi 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 nbli
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 fic se �
Yl d
Wi �L,yo be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
Y /
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7mmna fn rmminlata tha fnllnwina-
Reviewer to complete the following: -. -
Square footage of Use: q(4 5-4
/ N
Y/
ermitt
ed d as: CI
Under Section: �Mk A j
Supplementary regulation section:
Parking formula: �UW`
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Pat(
Notes:
Violatio s:
Y /
Ifs ,List-
Proffers•
if Ifs L'
Va iance
Y N
Ifs rList:
SP's:
Y/N
so, ' t:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3