HomeMy WebLinkAboutCLE200900158 Legacy Document 2012-10-01V4
Application for Zoning Clearance
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CLE# 2o0� "T $
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OFFICE USE O /�1
# Date: "I °; ;
Zoning Clearance = $35
PLEA, REVIEW ALL 3 SHEETS
Check
Receipt # -1 Staff:
PARCEL INFORMATION /• „ Y i
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Tax Map and Parcel: � Existing Zoning
(
Parcel Owner:11051
Parcel AddressAm) 1�. kI f-) Rd Unit ►'?D3City Cl. ALASvide State VA Zip Z Zq0 )
(include suite or floor)
PRIMARY CONTACT ,``,�� ' , ` 1
L`A1c�-�) f� W f 15uy-)
Who should we call /write concerning this project?
Address: t b Wf yr i' a c e. City V (I V State N A Zip r") 0--3q
Office Phone: Cell 943Y S S lax # E- mail (i&W 0,_C1 M QCtd' ► C"wn
APPLICANT INFORMATION
Check any that apply: Change ownership Change of use Change of name New business
�of
Business Name /Type: Pi '\�;C�i -cs
Previous Business on this site
Describe the proposed business including use, number of employees, number 1 of shifts, available arking spaces, number of
vehicles, and any ad�(rtional information that you can provide: �j ojIy,,(1l0 qqe oZ s��i� Q y2,.1'`� CAPS .
1a nk, narL" ► A, M&I lot
*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.
1A ILL Ma PG'a Printed LAS 0. �j f l Sb
Signature
ChNA Fen
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
Zoning Official Date �Z�O
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:
Is Isin, LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil bre 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 p� blic Ovate .
If private well, provide Health'a • ent
iUep form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that
parcel on septi or public sewe .
Y /0
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 #
Zoning to complete the following:
Reviewer to complete the (following:
Square footage of Use: I� 1
1/N�,permitted as: � ti
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
_Inspector : Date:
Notes:
Viol ; ns:
Y /N
If so, List:
Proffneg:
Y /;N)
If so, 1st:
Variance:
Y /NN
If so, L- sst:
SP's.
Y /]v
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3