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HomeMy WebLinkAboutCLE200900160 Legacy Document 2012-10-01Application for Zoning Clearance �_� CLE # g J7 �- /& 0 `' ` n �4tc;tNtP Zoning Clearance = $35 OFFICE USE ON�� 9° ec ,^1 9, Check # % %§ Date: lJ PLEASE REVIEW ALL 3 SHEETS Receipt # T (Q I Staff: off, 4r& PARCEL INFORMATION �n (f^ , -i'11 Existing Zoning � � aI V� _� " � Existin Zonin �ai.i,�i�(� �L Tax Ma and Parcel: -Ci Map UV Parcel Owner:F)--UE RIDS 40116 13ULi-EIZ5 �SS�DGLdk`�L�.D� Parcel Address: -330 [� µAOAJ � -ft4 -X a t L City (1 It 1L 7 ITP -5/1 -State U CI Q � li Zip -22% t h jC(ov (include suite or floor) PRIMARY CONTACT _ Who should we call /write concerning this project? A AP EL (�JC LLt CC°- Address : 12-tol /1AA -r f}E W1 Y Li- i�-� City `fZUCLLCl2SV I I-'eState d f-c(t Q l A Zip Office Phone: 85--(0q31 Cell # 142-' 23,n Fax # a 10- E -mail 'n u_aj e APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name )e New business Business Name /Type: kLE%RA S?A Jk- 'IGS *_A L( A-95 C- ` 2W_—P_ Previous Business on this site M "SAt�rC -I tEW --AE' 0V 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: 7if00CdQk, VNA sS a-ci e2 -RLc,,Ir" -e l sew iLo-Y are Yl4 S 1 e u1 -e 4 -- 5 A4—,5r-7f ctir(Ct 5n eycr cu54 t.a In �d -Ea ntir I >G sn� r E U� �t l c �� ©Vt� �r ©vwi i 35 Sk 44 �v e w� M 19. 191,9 -A *This Clearance will only be valid on the parcel for which it is approved. Ifyouldhange, 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 -� `) �-e.f Printed .fitCLAe A l;e LQ_c r, APPROVAL INFORMATION �/] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Bacicflow 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 V 17 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 1. toN Intake to complete the following: Yli Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Wil 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 public water? If private well, provi a artment form. Zoning review can egin until e receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or public Y/N Will you be putting up a ne 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 # ZoninLy to comiDlete the followin : Reviewer to complete the following: Square footage of Use: �H& meted as: p,` 4zZ e- Under Section: o��, 1 Supplementary regulati �s �sgction: Parking formula: t /„ O Q _\-R Required spaces: Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y/ If s L' Proff Y/ If st: Var' e: Y/ If s , L'st: SP's: I VILi Clearances: SDP's Revised 04/28/08 Page 3 of 3