HomeMy WebLinkAboutCLE200900161 Legacy Document 2012-10-01Application for Zoning Clearance
®
CLE # � 6'047 Ob d
z>
vlRCtcrP
Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: °?9 d
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION
Tax Map and Parcel: v 9 9 00 — Q — O 0_ 00 S o b Existing Zoning Co rnmeml a l
Parcel Owner: NOY-T G-Axr)FN CA055F,0hPr, )NC,
Parcel Address: 4 91 � ?LA K- F-D • City NOXTIJ 611DEgState VA ZipZZ95
(include suite or floor) .5V 1TE S
PRIMARY CONTACT
Who should we call/write concerning this project? 1E r M NTT 1R 0$I3
Address: 8863 T 1Gk 0601)l ILD City Af"V W State Y- Zip2Z9-1-0
Office Phone: (154) 823-'70 D Cellf' 4 531�6o60Fax#!� Z5-1- E -mail h'1aiforabdr",sltivc 1U11,caw+
'3466
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
L
Business Name /Type: � O �b QJY1S'h/ Ch m. Ca m g alnv �- b1n lci� -� OT Co ib yv% h�3 . %-C--
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: _( a n+b lava Qje.. 5 pAex_
*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 o the best of my kno led e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Sign, rim Printed
AP OVAL 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
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: Reviewer to complete the following:
Y / Square footage of Use: 5 �O
Is u4QLI HI or PDIP zoning? If so give applicant a Certified
Engineer's Report (CER) packet. (0/ N n
ermitted as: 0-111 'LPG
Wilcere be food preparation? Under Section: Aa- a '
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulAt� s section:
Dept. FAX DATE ((NN ��
Circle the one tha plies
Is parcel on p i to well or is ater?
If private wel r ide He artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the on tha applies
Is parcel on pti or public sewer?
Parking formula: 1 6
Required spaces: ' ( y� �c.Ce—)
Y/N
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
Y/N `
Will there be any new
If so, obtain the prope
Permit # i
or renovations?
Zoning to complete the following:
Notes:
Date:
Violations:
Y/l
If so, 1st:
Proff s:
Y /ICI
If so, List:
Va n e:
Y/
If so, List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3