HomeMy WebLinkAboutCLE200900208 Legacy Document 2012-10-15�gt31
Application for Zoning Clearance
CLE # aa-? — �,( )
Zoning Clearance = $35
OFFICE USE O LY
Check # 61 �(V Date: 9
PLEAS REVIEW ALL 3 SHEETS
Receipt # `7 J:7-67 Staff: cif
PARCEL INFORMATION /1
O G W- D 1— /uN
Tax Map and Parcel: l Z- o oo Z o o iT Z 11% ?R i l Existing Zoning
Parcel Owner: FRED A . 9RuN k-GEL f (tsE N S
Parcel Address: l41C' 5kL"M PIRGIE', STE ZA City CWA-9.LD- S&sot"LState Zip7,10t'Dj
(include suite or floor)
PRIMARY CONTACT
_
Who should we call /write concerning this project? rRhNuS 3
Address: SS5 901,9KoPT WiZ City C1{k¢Lora%T-So1i -L-E State V Pt Zip'LZ°to3
vko ►t 6
9f#tee Phone: 4( ;4) 2°lS $ 7sb�� Cell # 757 (o u1 %7 7,7-Fax # E -mail �
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name v/ New business
Business Name /Type: lv l L -Soo + x R�
Previous Business on this site K3 o V o Lu P- E
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: L pew Pt cg to 1-i a 1, sw_ o Au s %T cr—
rJo SuPe00-1, S-rhfF %-,x c �n ?14-e—ILPL, sekC* S , NCL,u-ef, ►) C>P -E *«i*-
*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 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature S;:::R ` �--- Printed
AP OVAL INFORMATION
[ vyApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 -z)- ( -- ®-1
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, 10/13/09 Page 2 of 3
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Wilt re be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or pu c w ter?
If private well, provide Health e hnent 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 wer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be a y new construction or renovations?
If so, obtain t pro er Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use: CIO 0
mitted as: as C4z
Under Section: 12a , a,
Supplementary regulations M sen:
Parking formula: k I ) -)-00
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Vi tions:
Y r N
If s ist:
Proffers:
Y/
If so, ist:
Vari ce:
Y/�
If so, ist:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3