HomeMy WebLinkAboutCLE200900194 Legacy Document 2012-10-15Application for Zonin1 Clearance
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CLE# Q— V
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OFFICE USE "Y
Q Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # !7Z Staff. 1rt S
PARCEL INFORMATION �,
D
Tax Map and Parcel: 061 cc' - 0 C — yc: — 9 L23<5t Existing Zoning
Parcel Owner: Pic A SSoc, tv TC- � C to DL, ,n ✓yt-r-
Parcel Address: City Ctrk\JtLt State j_%Pt ZipZZ't1)
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �d KT WA t--ye Ai
Address : 322-1. lid n t_ AA- R (a �J -J 6 City C, o %,J ((:LL— State VA- Zip 7,2.s1 i 1
+-i3W-9Gy.
Office Phone: (a{) �, ��'- � -'j Cell # S'c(, Fax # E- mail �y�
A L:3UM 1442-«: , 0"t q
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Cg--', At r L
Previous Business on this site
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: 'i `"NQ s0Q/-1t 14 ✓t — T2-� -Q_ .t
*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
read the conditions of approval,++ and I understand them, and that I will abide by them.
is true and accurate to the best of my knowledge. I��
)yhave
Signature Printed A;9 7, L VA- c,iLn r
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
Backfiow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xA1 . 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
Zoning Official '' Date
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:
Y
Is Lvin LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
y /
Willere 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 PU r?
If private well, provide Hea fth D.o rent 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 -��-
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit # 2��e J4
If so, obtain proper
Y
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
YIN
Permitted as: J�o --4 —e,4
Under Section: 44 '✓✓.
Supplementary regulations section:
Parking formula:
Required spaces:
YIN
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ons:
Y/
If so, ist:
Proffers:
YIN
If so, List:
Vari ce:
Y/
If so, List:
's:
", /N
If so, List: ll
gg �
Clearances:
al h ii
SDP's
Revised 04/28/08 Page 3 of 3