HomeMy WebLinkAboutCLE200900193 Legacy Document 2012-10-15VV
Application for Zonin Clearance
CLE # '`
�IRf;IN�P
Zoning Clearance = $35
OFFICE USE Q NLY
Check # � Date: `
PLEAAEVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION /„ ���
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Tax Map and Parcel: Existing Zoning
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�� 16/ 4
Parcel Owner: 19 , 1/
Parcel Address: 5 � �✓�e l�D�'Gis� City Cf O Z.G State V-1'--%i& Zip 229 2
(include suite or floor)
PRIMARY CONTACT
/write A LmA
Who should we call concerning this project?
Address: 17Ln WeSiWO—Y' _Dr% -jQ City C 4.1? b�Wtlk State \/` ye6 • in j.a Zip =901
Office Phone: L{" JV-T�& Cell # 45q46W9 Fax # 4N'W13Z839 E -mail al eklcy C4" (. eevrl
APPLICANT INFORMATION
Check any that apply: Change of owners_hi�p Change of use Change of name New business
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Business Name /Type: Cr'07G.��dS,�G�eaD� C�i-tZL� &eely
Previous Business on this site BM-F ze k
Describe the proposed business including use, number of employees, num�er of shifts available parking spaces, number of
•eS 2 C
vehicles, and any additional information that you can rovide: b �'L�l aMe4 S l
�
A&-L
*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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate tAie best of my kno dge. I have read the conditions of approval, and I understand them'', and that I will abide by them.
Signature Printed ",ni �J . fCf G.+�C le y
AP OVAL INFORMATION
[PI Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, X-149: 11 +
[ ] 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 t 0
Zoning Official Date l l j I l Oct
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
Intake to complete the following:
Is / I�l
Is t�i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wilt re 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 wa ter?
If private well, provide Healt De .pa&ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p V ewer?
Y/N
Will you be
Sign permit.
Permit #
Y/N
Will there be any
If so, obtain the p
Permit #
a new sign of any kind? If so, obtain proper
er Permit.
or renovations?
Znnino to eomnlete the followino,:
Reviewer to complete the( following:
/ g
Square footage of Use: o 0
Permitted as:LW
Under Section: c��l
Supplementary regulations section:
14 4l
Parking formul :
Required spaces:
to be verified in the field:
Inspector
Notes:
Date:
Viola s:
Y/ Jq
If so, ist:
Proffers:
Y/
If s, , st:
Vari nce:
Y/
If so,
SP's.
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3