HomeMy WebLinkAboutCLE200900143 Legacy Document 2012-10-01Application for Zoning Clearance
1*—
CLE # &}q " 1 #3
Clearance = $35
OFFICE USE ONLY
Check # I ] oZ' Date: 01 62`ac/
/;e_✓
PLEASZoning
REVIEW ALL 3 SHEETS
Receipt # (Q Staff:
PARCEL INFORMATION /
su v ��Q Zoning l�
Tax Map and Parcel: Existing
Parcel Owner: LAO LE SE-b TJY F-L A 1
\ /
KID W 1`- City CWA V2,1_0 6SV IU.F State A Zip 22963
Parcel Address: 550 ?AD� V
(include suite or floor)
PRIMARY CONTACT _
Who should we call /write concerning this project?
Address : 803co -D L5CoV�k� Dr-w F City P Lc RmoND State \'A
zip2322°1
Office Phone: &�) 7S-7- 111 4 Cell #A *1V- Fax # $09 -787- M5 E -mail — 4�'AMOA aV1J +c6
80K -335 - $70(0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
p
Business Name /Type: T�jB T ��►J11�
Previous Business on this site h/A
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: INK Z?,AAN H
*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 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 know dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ,—/ Printed A .7om PN6W
AP OVAL INFORMATION
[v] 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 hysical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site an.
This site corn lies with the site lan as °�thi�jda e.
6 Z�I 6
Notes: '.J09S �' �I OgI L
_-
Building Official Date
Qj
Date ��
Zoning Official i
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 I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will e 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
liew er?
If private well, provide Health form.
Zoning review can not begin until_ we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p lic wer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # &irej -
Y/N
Will there be any new construction or renovations?
If so, obtain the: Perm.
Permit # °
7nnin¢ to emmnlete the fnlinwina:
Reviewer to complete the following:
Square footage of Use: / (°
C/ N
Permitted as:
Under Section:
Supplementary regula 'ons section:
Parking formula: ,
Required spaces:
4-cp koJ
NI I
Items o be verified in the field:
Inspector :e�J Date:
Notes:
Violat' ns:
Y /
If so, ist:
Prof erF.
Y U�st:
If
Var'
i'
If so, List:
S 's:
V /N
If so, T i.sUG�1'
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3