HomeMy WebLinkAboutCLE200900138 Legacy Document 2012-10-01r
Application for Zonin Clearance -®
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CLE # 00q " l'8
v�RCrN�P
Zoning Clearance = $35
OFFICE USE ONLY
Check # '7 y!1 Date: ' 2�ea p
PLEA REVIEW ALL 3 SHEETS
Receipt # Mg214 1Z Staff: 1 IJU rW
PARCEL INFORMATION
Tax Map and Parcel: 57SS E - 451 - (� Existing Zoning N M
Parcel Owner: RA-2LR VADO lTA 4
Parcel Address: 1 VSAS (JeLecity Ceo-teir State t/A- Zip 2:7qS2.
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? SuSA K ��TizoN
Address: P.O. gCP)-�' :W4- City CWA0bTMy1 U,F_ State ✓,A- Zip 224te�_
Office Phone: U 7g5•044q-Cell# ±�lD (oS1la Fax# E -mail :5VC -* v% glmdo6tvt tIt -'6V-
APPLICANT INFORMATION - -- - - - -
Check any that apply: Change of ownership Change of use Change of name New busine
Business Name/Type: 8aY5 + Crl eL S 6L uM 0110 -1 K& -CJt; -c-F N &£ r �f • 2�A • 4S �$�
Previous Business on this site
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: Tke- F bC- C*Ai%e, Ck%.Uc—� w11 1,-t- Isi" x+-ham, C(
Tvt( Towat &A-4,,r . Wt- eaeeeefi —200 r,A -✓S 2.4 — E0 yoly Ai- r . -FL,.: ecyes - n&W es x4tmh d .
A4- 66! TAI , -h-wt will 6e- o� LJOy6a 4o e u A- ,2 10 r Ub w.sf sip 4- ow -F.a_ a mN- .
*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 ow '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 rie . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed SUSAN. H. r-eq Q g
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions Z nied
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451 t
[ ] 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 coin lies ,it �thitMan �this at .
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
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Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give ap
Engineer's Report (CER) packet.
Y/N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive al
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 apI
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/N
If so, List:
Variance:
Y/N
If so, List:
Clearances:
Inspector : Date:
Proffers:
Y/N
If so List:
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Sgt_
SDP's
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Revised 04/28/08 Page 3 of 3