HomeMy WebLinkAboutCLE200900148 Legacy Document 2012-10-01Application for Zoning Clearance
�/
� Zoning Clearance $35
OFFICE USE ON Y
Check # 1,3k, Date:
=
PLEASE REVIEW ALL 3 SHEETS
Receipt # - Staff-
-PARCEL INFORMATION - - - - - - -
Tax Map and Parcel: 07poo- oo -m -oi 5A I Existing Zoning Us, tied
Parcel Owner: PAN TOPS 6;(Rwr LL-C --
Parcel Address: 19W neef�Ll VORD City C4Pr2LOjTEn)V1U,6tate ZipZZq
- (include suite or floor-) -- - - - - - -- -- - -- - - - - - - -- - -- - -- - -
PRIMARY CONTACT
Who should we call /write concerning this project? W I (.i_ CAL ._N 1 NF- - i-ecET C':e p-pemTe s
Address: jai s &Ll'Y1( SST, c`7Uj I 1J City (1 CHI State Zip .19Z
Office Phone: r!i( 10 )150-3533 Cell # Fax #AIG E -mail 1i Ipc)1d C O/N) &"'}Ye t
x I 72S corpenlGrs_c
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 5C6*T7J2ADE OFF1Cf- (�C�ti���U�- �Yu W-1 0
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: LJ Em JFFS, LI 6,243 . PLLLEV eOC7
ff0j gJeJAf2.3 SP,ICE5 nU C , F. I�'1 -1= R ;5'o r - s Ph'I
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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature��iG�� �?"�- Printed /z55A°CA- tiw�
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:
Building Official = _ Date I (°I
Zoning Official Date ��,Z6 A t '
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
Reviewer to complete the foolllowing
1
Square footage of Use: U�
N n
pitted as: Qt l u/
Under Section:
Supplementary regulations section:
ZoninLy to complete the following:
Viol ,bons:
Y/
If so, st:
Circle the one that applies
Is parcel on private well publicc wa
Parking formula:
U J
If private well, provide Health Department form.
Zoning review cannot begin until we receive - approval from Health -_
Dept. FAX DATE
Required spaces:
SP's:
/N
If so, List:
Y/
Circle the one that applies—..-
Items to be verified in the field:
Clearances:
Is parcel on septic public sewe
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
__- -
Sign permit.
-Permit # - - - - - -- - -- -- - - - -- -
Inspector - - - -- Date: _ - - - -- - - -
p
- - -
N
Notes:
ill there be any new construction o renovations
If so, obtain the proper Permit. 4-` C TF ( 04k -
Permit
ZoninLy to complete the following:
Viol ,bons:
Y/
If so, st:
Proffers:
Y/
If so, ist:
Variance:
Y/;
If so, List:
SP's:
/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3