HomeMy WebLinkAboutCLE200900153 Legacy Document 2012-10-01�L�SC- c�4-LV w4eIJ
Application for Zoning Clearancet
[Zoning Clearance = $35
OFFICE USE ONLY
Check # Dater r
PLEASE REVIEW ALL 3 SHEETS
Receipt #'1 Staff- rrei
PARCEL INFORMATION
PARCEL
Tax Map and Parcel: 1 AA r_18 — 15 6) S' 1P CL ICJ C'S Existing Zoning UYA.0 c2wi M OVIC.
Parcel Owner: �1JU41AI /A LAND -11"R0571—
Parcel Address: 1e)2- SFoTN A P A S +eA-&ity l-,' U L I U State VA Zip
(include suite or floory 810 5F
PRIMARY CONTACT
Who should we call/write concerning this project? ��(� 1/VI.P_�1i1✓
Address: 1 !? 5 ) City `lt U (I fQ State i)k zip 2-2156
Office Phone: ( 1 I Cell # q6b Fax # 216-35 10 E -mail V L. C5 M P I 91
Gto
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓New business
Business Name/Type: V N Y7
S9►rl l LS2..—
Previous Business on this site �D • ,
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: ,� [ 0='5
-- 2
*This'Clearance will on y be valid on the parcel for hich 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 acc a the est my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature q/2 i Printed -el/1 I
g
AP OVAL INFORMATION
[ VJ 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 ~
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
i', va�►►� c� �k ems►► n c� C� ►�►-4 ��, �� S�d�Sl �u A-2-
Intake to complete the following:
Y
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / Ti
Will t 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'wat .
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o is sewer?
Y
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnin4 to emmnlPtP the fnllnwinu-
Reviewer to complete the following:
Square footage of Use: 5 i o
PIN 1
Permitted as: l cPJ ,&Ca Ads {�rM�i /
Under Section: W. I. I
Supplementary regal tions section:
(a
Parking formula 9... 0 Ap-a
Required spaces:
YIN '7
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
sOist:
Y If /
Proff
Y /r:
If so, List:
Van' e:
Y�NJ
If so, ist:
SP's:
Y/
If so, Q t:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3