HomeMy WebLinkAboutCLE200900147 Legacy Document 2012-10-01Applicati ®n f ®r Zoning Clearance
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CLE # C7'1 ' 1 617
❑ Zoning Clearance = $35
OFFICE US O Y
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt# 7&332, Staff:
PARCEL INFORMATION
'fax Map and Parcel: 2 _ (7(:::f Existing Zoning
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Parcel Owner: �i1. 1i w 4 � PLUS r I . , a l.- . 1 11 1 , K a nl
Parcel Address: 15 4-1 a , a a o a-r a.0 a h . City 02-. A-a-L -tt-es di, L e State V A- Zip zz9 I
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? t &L_ Uj tts o'
Address: 3 -3 4f3 aLLAet(_'Y Qu CityP)4P_A6uaAoiLL_- State jp, Zipzziz3
Office Phone: (y 3y) q q x . t3 �j Cell # j31 -41, 8 q Fax # 97-:� fi l E -mail �cCa7 r►1o� u U �Ytr1i n i a • cv
APPLICANT INFORMATION
Check any that apply: _ Change of ownership Change of use Change of name New business
Business Name/Type: M 0'ro U 10, c i n i q � PoQTin e �y- N�p7 �r - _votes ANf. j �N9u�ca rio ncl
35eMJ3 Ll
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: Gku -i m ru (y t o�c, ac=t 10p ,� �tj r e 5
i lY P_f+ir �
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature l - Printed t� tR.K Lci ins ant
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 an ps of this date.
Notes:
Building Official Date
'I 12k Cyi
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
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 approval from Health
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 approval from Health
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 permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use: Z3 30
/N
Permitted as: r yiuyLvCl-vLz4 yy 1 r ' vic1, I ►� J� 1�6
Under Section: 27- a . l
Supplementary regulations s�tion:
� tf/
Parking formula:
[ 1�YO4 +Yi
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3