HomeMy WebLinkAboutCLE200900204 Legacy Document 2012-10-15PRIMARY CONTACT
Who should we call /write concerning this project? Fgy,4
Address: vim,- t9 d City 1Cy"V- k9—, -f r lk State Z4'7 ?6 1
Office Phone: l r71 -��� Cell #J c1✓W6 `Fax #` - t —G -mail
APPLICANT INFORMATION
Business Name /Type: /l/d �;� �%r� ���-7� l
Previous Business on this site /� >% �'1%'y►n �P �/��'�� {vr�: rl �j/✓N► -�iJ
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number o
vehicles, an.d any additional information that you can provide: XI-g- OA ,,;U44-/Zr% Al"MI!' /0� ✓��'�
*This Clearance will onl v 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 re li d.
I hereby certify th'a own o hav hwowner's permission to use the space indicated on this application. I also certify that the information provided
is true and acgdr e to tlh s /1 oiy�Wvi)tdge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signaturq /L4 l � - � tit /% I Printed at+'a✓ C� ��,
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, 10/13/09 Page 2 of 3
Intake to complete the following:
Reviewer to complete theq following:
VIN
Square footage of Use: /
use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
/ N �)I Xb
l �✓ —A l `✓
rmitted as: /nk) t, ;�Ct
Y ANJ
Will ere be food preparation?
2,
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or ublic wa ?
If private well, provide HeaIt—filTepartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y /
Circle the one that appli
Item be verified in the field:
Is parcel on septic oz ublic r?
Y /`.J
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes: i
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
/N
so, List:
Proffers:
®/N
If so, List:
Variance:
Y/O
If so, ist:
SP'
Y
If so, List:
Clearances:
SDP's
Q ii 0
Revised 04/28/08, 10/13/09 Page 3 of 3