HomeMy WebLinkAboutCLE200900162 Legacy Document 2012-10-01Application for ZoninLy Clearance
/UZ
CLE #
❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: q&d o q
PLEASE REVIEW ALL 3 SHEETS
Receipt # 5 O cl - 4 Staff: d Qff
PARCEL INFORMATION
Tax Map and Parcel: Ti4 p ; j J Phi 2L �p % Existing Zoning t�
Parcel Owner: Albema4e, Coup i)�
Parcel Address: /�0b CYoa� 11 yeli ye, City croz_e - State V14 Zip 2- 2/32-
(include suite or floor)
PRIMARY CONTACT q&,-_T 4e Cevnit ger4,2ra1 Sevvic4s
Who should we call/write concerning this project? ra, 5n'Id,11 '! an ter ✓ , fi ei*-i
Address: /Va/ City %haA0'1kSl1111e_ State_ V,4 zip 2��(��
Office Phone: AA u2 q& ""5% Cell # Fax # T72, - 21J 26 E -mail _ InhdAwn 6,)g1A,,wde ord
APPLICANT INFORMATION
Check any that apply: Change of ownership Changee of use Change of name New business
J
Business Name/Type: Old Gi''O -76t ..SG A001 /4 44_s• 6� .S' �Il�f�f tl�r� f fe'7SI,'i/I C t�:7
Previous Business on this site Wd/ orO Scliay !
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: Oc51) i.5 el SChaG%'^r aj"� ;',uiYUeHyi.?I we ca4 "A
have, M /fa fnaar,M14 �n /,��o A6gC19 046 r. r �crr' .I/�S.S s wey ryeek - Jyc haw 41iree an- i�w /e em
-0_411 -wral ma4 i= yo am, 4Mwll ie or mere c ix cc•rc.lGzs���7�
*This Clearance will only be valid on the parcel for which it is approved. rf you change, intensify or move the use to a new location, a new Zoning
�learance will be required. eIrtc�.iy lot wi %l haile s' . GK'S ^6,— �"� C�3r5 . ,�jij�yj7 y oic �! i SfU�d�'y/1S G(� �
���ped of h� Pare))•g ; p al-ed cep � -he l o���je�or G�a����� �o Y� �epaj-k wjji �� �he��;
I hereby certify that 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 L Printed Sh&-flt7.P 16, -fi G
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, xl 19.
[ ] 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 pl n as of this date.
Notes: C 0(- 5P 0 Cl - q i m a x S�GL
�f �
l GLP
Building Official, Q,��— Date J
Zoning Official Date ® 'S
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 /0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y-
Wil 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 or p c w ter?
If private well, provide Health Went form.
Zoning review can not begin until we receive approval from Health.
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or pi blic sew r?
Y/N
Will you be pu mg up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a y new construction or renovations?
If so, obtain the roper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �C1
,Nrmitted as: '(1 V(Ak 5c*, ub
Under Section: Ij _ �j� Ov
Supplementary regulations do
Parking formula: J5 tic
Required spaces: 6
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol �o s:
Y/
If s¢, ist:
�r fe s•
I so, List:
Variance:
Y/�
If so, ist:
's:
N
soCLi t
q. - qi - m c e A z% 1
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3