HomeMy WebLinkAboutCLE200900165 Legacy Document 2012-10-01Application for Zonin Clearance
CLE #
`�RGIN�p'
Zoning Clearance = $35
OFFICE USE ON Y
Check # % Date: I R
PLEA IVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION c
C` ,_� '� ^61 `� 1'� Existing Zoning c,
Tax Map and Parcel: ar
Parcel Owner: NIRLNIA L±4NL- iQ usd
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Parcel Address: ` q I-Y4 l� a fO C • City �j' �L State V Zip ;�a ,() I
(include guite or floo) -l_
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PRIMARY CONTACT
Who should we call /write concerning this project? � c ) _yf ( le jbo,/
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Address: l , Y�P�1 I D P (/1C'� City �� ( [� D State �/ �� zip Q,
Office Phone: f tM 01 Cell # �o r��r� Fax #�(p -�j�� 6 E -mail J 1 C J� GYl i� �DV) �aa
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: M D_ t uL )/rl) 1 r
t�15- d vvc _r VY) 00-P-1 S 01
Previous Business on this site _
V
Describe the proposed business including use, number of employees, number of shifts, available parking spaces umber of
vehicles, and any additional information that you can provide: '
r J
G'C
*This Clearance will only be valid on the parcel for which it is approved. If you change, intens fy 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 be t of , y knowledge. I have read1he conditions of approval, and I understand them, and that I will abide by them.
i
<Signature , Printed /1't L L 7-b A-2
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'D L_g
Zoning Official Date //(J Z %�(.l,/
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
Col-v�
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Intake to complete the following:
Y/N
Is m 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 public Ovate
If private well, provide Hea apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl' --,
Is parcel on septic•o public sewe .
Y /
Wil be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Wi l re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the following:
C-;b
Reviewer to complete the following:
Square footage of Use: J
/N 1 I
Permitted as:N;f
Under Section: �y 2 • U
Supplementary regulations section:
Parking formula:
IL/ U a
Required spaces:
Y/N y
Items to be verified in the field:
Inspector • Date:
Notes:
Violat'ons:
Y/
If so, List:
Proffers:
Y/(V
Ifs , ist:
Variance:
Y /(9
If so, List:
SP's -
Y/O
If so, List:
Clearances:
Cg S ZS
SDP's
6 G--z
S
Revised 04/28/08 Page 3 of 3