HomeMy WebLinkAboutCLE200900137 Legacy Document 2012-10-01Application fo Zoning Clearance®
CLE # 00g `° / 3
ing Clearance = $35
OFFICE USE ONLY fn
Check # 3-70-3 Date: V /,•
PLE ALL 3 SHEETS
AEVIEW
Receipt # 1(j) ,3q Staff:
PARCEL INFORMATION //� - - — -
Tax Map and Parcel: 09 P) -0 D ~ (�� � �� ` y1(pAo Existing Zoning, f�l
Parcel Owner:
Parcel Address: 0-� S . �G�VI1(ys 04 k2ni City c �l I k, State Zip,22gI
(include suite or floor)
PRIMARY CONTACT L
�Xf�V �rn P 0
Who should we call/write concerning this project? I n,
Address I � � t ����I �ky�C' . City . iil.i I. [ I -e. State Zi p 221/I
Office Phone: l3 -1 '7 1 -Nf Cell # �rj Fax #2 I E -mail Ctrl r
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name New business
y ,Change
Business Name /Type: ' 4C1LP 1 1 Ll -
Mr7r,tnCIrle V L�
Previous Business on this site, J tJ
Describe the proposed business includingJe, number of employees, number of hifts, available parking sp c s, number of
vehicles, and any additional information that you can provide: Cu 0
6�l 1 / _
v1A
*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.
1 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
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, 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: ,-
'40 l MA—, . q --t ff .0
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
Cot"
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103 &u, , ?a,-,Tw6 bu�� 2 oZ
Intake to complete the following:
Y/
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o pubfic sewer?
Y /
Wil 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. A
Permit# `� l �36Ac,
Zoning to complete the followin
Reviewer to complete the following:
Square footage of Use:
(� `� �o
IN ,J(�
ermitted as: 04kc 4 - M L
Under Section:
Supplementary regulons section: - - --
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
i Inspector:
Notes: /1
Date:
Viol -ions:
Y U
If sList:
Proff s:
Y/
If so, List:
Vari nce:
Y/
If so, ist:
SP'
Y
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3