HomeMy WebLinkAboutCLE201200199 Legacy Document 2012-09-25Application for Zoning Clearance
CLE # Z I cicr
PLEASE REVIEW
OFFICE USE ON Y
1 C)
ALL 3 SHEETS
Check # Date: -
Receipt #M59S Staff-
PARCEL INFORMATION
Tax Map and Parcel: 7 -- ZIJ Existing Zoning 1 bm�/
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Parcel Owner: 1_ C- ,4-Or' LLC-
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Parcel Address: 1LIto City �l�ic�rld l l sys (( State Zip 22 lrl
(include suite oruoor) ... . . .
PRIMARY CONTACT
Who
should we call/ /write concerning this project?
Address: 19S' Y <<VE'L."I `bY` City State V/; Zip Zzl //
Office Phone: (ay) 9-71 819( Cell # Fax# E -mail eve(�?vir�;w�ee �nndccn�,awy
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: "R /J S
Previous Business on this site N(91J i_ — N Gt j C-p10g�7— KUC T ICW
Describe the proposed business including use, number of employees, numb r 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
CIearance 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 accurpr t e be t of my knowledge. I�hav�e read a conditions of approval, and I understand them, and that I
will abide by them.
Signature 1 �`, 1 Vim, ee;' Printed S7_` P *1_ ,_)_X
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, x117.
[ ] 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 `2✓ Date
Other Official Date
�V, Ly Vl ra,uc,uarle meparimem ox t;ommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y / �l
Is us ..{n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(D
Will there 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 ublic 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
Is parcel on septic or public sewer?
Y /� _
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 # tj in ,2ota - OtG74?" Ac-
Zoning to complete the followinL-:
Reviewer to complete the following:
Square footage of Use: 1'4 5?
/N
ermitted as:
Under Section: Z-mtn -�7-.,o�J� /2--
Supplementary regulations section:
Parking formula:.
Required spaces:
s
Y/
Items to be verified in the field:
Inspector • Date:
Notes:
Viol tions:
Y /
If so, List:
-4troffers:
(YJ/ N
l so, List:
03 —
Vari ce:
Y/
If so, List:
SP's:
Y/
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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