HomeMy WebLinkAboutCLE200900201 Legacy Document 2012-10-15Application for Zoning Clearance
IS
CLE # 20C)R — 6"
[Zoning Clearance = $35
OFFICE USE ONLY
Check # OA, 6 ff Date:
_10qcl
PLEASE REVIEW ALL 3 SHEETS
R Staff:
PARCEL INFORMATION /'), l i
`J I' I Existing Zoning
Tax Map and Parcel: lfL I
Parcel Owner: cj , rd o V) 5 7n(T S , /Y 1 G 6Ce AI 0�
a F�, F--, i )2-j. � �'
Parcel Address: UC) V . City I State + Zip G
(include suite or floor)
PRIMARY CONTACT
Who should we call / write concerning this project? Q d
Address: � 0 UA City 1, I State / V . 6 Zip
Office Phone: Cell # IN ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Jr!Business Name /Type: 2 C. "2S_M
Previous Business on this site O& � t)'
Describe the proposed business including use, number of employees, nu}� of shi is a a�lable parking spaces, number of
/ E2
vehicles, and any additional information that you can provide: 10
*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.
r�
I hereby certify that I own or have the ow ier's perfnission to use the space indicated on this application. I also certify that the information provided
is true and accyr to the best of my ledge. I have read the conditions of approval and I understand them, and that I will abide by them.
Signature Printed
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, x - . ,
[ ] 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 om lie with the' ite plan as of this date.''
Notes: Z �l�t�
JA ,�
tt
Building Official Date I l Z" 1 3
Zoning Official Date 1� /
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
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Intake to complete the following:
Is/
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /Ni
Wil 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 o l;- ater9
If private well, provide Hea apartment 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 lic sewer?
Y /
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Y /9�'fere
Wil be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninv to vmmnlal-a the fnllnwina-
Reviewer to complete the following:
Square footage of Use:
rN
ed as: 4"", "7vv
Under Section:
Supplementary regulati ns section: ,
Parking formula/
sF_ ; vs-t, c�
Required spaces:
Y/N
Items to be verified in the field:
Inspector : / Date:
Notes:
Violations:
Y /N,
If sa t:
4
Prof r s:
Y /.0
If so, List:
Variance:
Ifs rL t:
P's:
if 6,�
if _L'st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3