HomeMy WebLinkAboutCLE200900163 Legacy Document 2012-10-01Application for Zoning Clearance
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CLE # %Oq -' 3
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I!'1 Zoning Clearance = $35
OFFICE USE ONLY ` / b (� ,V q
Check # 0q C� Date: U
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7651o,14 Staff. _J_7 A W
PARCEL INFORMATION
/ 11
Tax Map and Parcel: Q (o[ — W 0 —Q%— op — 6 o2- o o 1? &eCdnQ Existing Zoning pZ i e 10
Parcel Owner:_ L I-C I/f_ C/o /�P, Z�_C'fy �y ,r44� ofy
Parcel Address: / /_1 -9� e, ec-e City Ckt,(C4A7SVi"& State VA Zip Z?sfof
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: ���� -.� �. /� s? ,ay �', z i" i "� City ,t I C`712r-t,✓% -State G� Zip �? %C1 p
,�.��� r
Office Phone: l ' .3 rl .3 � sv Cell # ` -3`f "16'1 Fax # L� 34 Y72) E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: n �' see L LC / C`
Previous Business on this site }ACC 0 its
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional informati on that you can provide: S i c ev. �h cow\ uv , 2
ZK tiw_zS.
to a( A✓ir U �.(LL 5- cPS.
ct/ U
*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.
Signature / Printed
A ROVA INFORMATION
[ ] Approved as Approved
proposed [;e 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 s' onaplies with the sit plan as of this date.
Notes:
Building Official Date Q��
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:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(0
Will there 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 lic water.
If private well, provide HealtFrDepar-tnr nt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic blic'sewer..
Y /Lw
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil sere 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: ft No-,x, • 17 72 c
Y/N //�
Permitted as: ��(�C� Inge CTVI/ 4
Under Section:
Supplementary regulations �ection:
� 0
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ' ns:
Y / l&
If so, List:
Proff s:
Y /
If sowist:
Va co
Y N
If so, ist:
SP'
Y /
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3