HomeMy WebLinkAboutCLE200900171 Legacy Document 2012-10-11Application for Zoning Clearance
CLE # — /T
`IRGIN�P"
Zoning Clearance = $35
OFFICE USE W* Q
Check # �q % Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # Staff: /Ia/
PARCEL INFORMATION J � � � 6ovell'd � � Tax Map
Parcel: , ° Existing Zoning
and
Parcel Owner: IF 0.113 LcRnd 1 rust
a
Parcel Address: Z44 0 Gv r,nman uJea L-1-11 1)r City 0.io,(r_r 1 n TTe s o Ji P State \JeL Zip �,A 90,
(include suite or floor) S.ta j� C.
PRIMARY CONTACT
Who should we call /write/cl1oncerning this project? rd- A L cLA P
Address: J 3 q D Qv, City State Vex. Zip a A90 I
Su Te. C
Office Phone: (q3D J93 - (Q"j00 Cell# ;3►S -5„18- Sl0+ax# 13 -lv7oo E -mail Y �CtYata or ®� tLr�zzn. nit
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
� s
Business Name /Type: t�R%1icird P. )_CLRUe - i^an�n�su.� fi �- nsl>Yance �1<inn'1rin
.Previous Business on this site =0 nsc>`rncP, y FFiea_
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: ':T- n55 ;-van« + S n unsrt nor, s
(9 Fmplrayee� a�i r1 ►'nn
1 1
*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 of my knowledge. I have read the conditions of approval, and I understand them,, and that I will abide by them.
��to��the����best
4x I-�f Printed R L A. �-, Qan
Signature l�C`� L C, r y, C%, _
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, 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 plus with the site plan as of this date.
Notes:
Building Official Date i 0 `I
Zoning Official Date I D
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
• f.
Intake to complete the following:
Y /0Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will 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 publ1 ere
If private well, provide Health epa ent form.
Zoning review can not begin un we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p lic s wer?
Y/N
Will you be putting ups new sign of any kind? If so, obtain proper
Sign permit. h
Permit #
Y/N
Will there be any ne onstruction or renovations?
If so, obtain the proper P rmit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �0
Permitted as: �� • oC
Under Section:
Supplementary reguns section:
a
Parking formula:
Required spaces:
Y
Items to be verified in the field:
Violat'_ ns:
Y /
If so, ist:
I
Proffers:
Y / ffe
If so, st:
1
Variance:
If /
If so st:
SP's:
I
Ifs , L' t:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3