HomeMy WebLinkAboutCLE200900178 Legacy Document 2012-10-11Application for Zoning Clearance
CLE # Q 0 0 jf zs b 179
OFFICE USE ONLY
Zoning Clearance = $35
Check #D Date•1
PLEA REVIEW ALL 3 SHEETS
Receipt # 7�5/ Staff;. STS
PARCEL INFORMATION �
Tax Map and Parcel: -�`n - Ql f�M u Existin zoning—i
g
Parcel Owner: 10-25 ",d --
Parcel Address: i 0� ���' S . �Q City L Dj f j p State \14- Zip .
(include suite or floor)
PRIMARY CONTACT
��/�,,
Who should we call/write concerning this project? (F-P ue V ► ��l ' I LN 1�
Address :I \wAj k City (:!;(A (��� State VA--- Zip
Office Phone: �.`�q4 I �! Cell # ��, a���Fax # �j} E -mail �/i l�
APPLICANT INFORMATION
Check any that apply " . Change of ownership Change of use ., Change of.name ., X New business:::
Business Name/Type: ral manck Acievicu
Previous Business on this site k IJ iJAa� 5�)o6 Q r-�^)Lk
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and y additional information that you can provide: A61 y) - e �5ra o ap
'
j -t9
*This Clearance will only be valid on the parcel for which it is ap oved. 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 an2accur o t he be of m knowledge. I have d t e conditions of approval, and I understand them, and that I will abide by them.
Signatur G ��_ Printed 5TrZ • /t L- LSD
"
APPAOVAL INFORMATION
Approved as proposed [ - ] Approved with'conditions [ ]: Denied`
[ ] Bacld3ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xI 19
[ ] No physical site inispection has been done for this clearance: Therefore, rt is'not a;detenrunat on of compliance with the existing 1.
site plan "
[ ] This site complies with the site plan as of this date
Notes :!' to
Building Official `. Date
:
Zonin g Official D
Date 2Z q
Other Official .' ` ., Date
t.:ounty of Albemarle impartment 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
I o3 � • 1�u..fv�5 �I ua�
Su�2. X01
Intake to complete the following:
Y /0
Is use in LI, M or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will 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 privateyve or public water?
If private well, provide Hea parhnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic public sewer?
Y /'a
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y%N
ilI there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #91 m / [ A
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: V0.0
tted as: v `C
Under Section: '9* �_, l
Supplementary regulati ns section:
la
Parking formula: 1 _0 -6 n
Required spaces:
Y/N
Items to be verified in the field:
Viola ons:
Yj�
If s� List:
Proffers:
Y
Ifs 5 st:
Va ce:
Y N
If so, ist:
SP'.
Y
Ifs , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3