HomeMy WebLinkAboutCLE200900191 Legacy Document 2012-10-15Application for Zoning Clearance
CLE /
Zoning Clearance = $35
OFFICE USE NLY, ` 1
Check # `7 Date: /d
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION.° /
t5 / J ) 3 3
Tax Map and Parcel: Existing Zoning
Parcel Owner: 511 -M.iiU G CCw 7-FA ASSeCZA7 ES CA> Sid-fu
Parcel Address: /&C, 'e- Pi t o g-:? . City 6144 P Cv 776 S- tate V �i - Zip's q v
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? yo-Sc eff As "A E w
Address: 1?ffl robacAJ c.l -#'( I City M h A/?K5AS State U Z1pQM1-
Office Phone: (�o3) S"ol( Cell#X03 - }25 -SoLf Fax# E -mail )1c5EPH- 14I@MSN-6o t
APPLICANT INFORMATION
Check any that apply: Change of ownership hange of use ange of name New business
Business Name /Type: C.)1" ; S TM o s :" E F6 silt-1-5
Previous Business on this site /� ,s%-f�o /U �q V1►'/° /�l l r% 0 k-Z'N G Z 7
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: -TP. FE Sfl'LES 3 M PCzYGFu S .
,i
Slf�,�� /f kiAvG LoT E2X oT,xrwG
*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 ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed V- S Er S M l✓ l� ! S l�
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 --#.4 11 1 L B
Zoning Official Date 10�
� / /' ,�,
Other Official �/rZL` t Date 13 /QF
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/N
Wi 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 or public water?
If private well, provide 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 septic or public sewer?
r Y N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to completed rt a following
Square footage of Use: I"
Permitted as: 'W66 6me J"
Under Section: 6b U---j
Supplementary regulations sgction:
Parking formula I • cr/pl)li'
Required spaces:
Y / N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If so Lis :
If
Proff rs:
Y /
if , ist.
Va a e:
If N
If L' t:
SP's:
Y Q�
If so, L st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3 .