HomeMy WebLinkAboutCLE201200198 Legacy Document 2012-10-08IRI t17, M1,
Application for Zoning Clearance
CLE # ' Q 12-- I%
OFFICE Ur ON Y
7J1 f ` t2-
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION H C
Tax Map and Parcel: � y Is Q O OO QO Onn ci y Q Existing Zoning
I ,,
Parcel Owner f',P\ N T=ei ll 2.! Q nk on't 4.� Auk 0"i-u u
Parcel Address: 100 Ma ZipZZgy l cr� f
(inc ude suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1 O Q
Address: 1(Z)o r \VRh �brtyt City \"V%CLrVO1kSW11tState ZiplZSa I
Office Phone: C 9" 7 20 MOCell # Fax #.q 39- � -mail A— Ki Uh-tCsM (CYA
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
1
Business Name /Type: CcAn i Q.� A c a% enis-�1 - O cLy- de a- e(-S tD
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
-T2n+ k b
vehicles, and any additional information that you can provide: I V cd O rl
�n 6 A -t \Qn 1- . Q -1` 4 . 150Y Ste. is .
*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 urate the f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Sign ' OlC. Printed „ \
APPROVAL INFORMATION
,"W- Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 cJ�1! -� —� 1 Date rt't ` a
Zoning Official Date zc"1 y
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /N®
Is use in LI, HI or PD1P zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wiptere 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 o public water?
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
Y NN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the followinL:
Reviewer to complete the following:
Square footage of Use:
&/N
Permitted as:
Under Section: ; ; CA,
Supplementary regulations section:
Parking formula:
Required spaces:
YIN
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Y /-'
If so, LAt:
Proffers:
Y /
If so ist:
Variance:
Y/f
If so, ist:
SP's:
Y/ iJ
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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