HomeMy WebLinkAboutCLE201200230 Legacy Document 2012-10-26Application for Zoning Clearance
CLE # o?6 0
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff.
--PARCEL-INFORMATION
Tax Map and Parcel: 631-00-00-01300 Existing Zoning- SAAnnl
Parcel Owner:_CoLxv%+v J Alkmerie- 13awafci
Parcel Address:. 1151 Aybn 45r1: F-X+. City Chatq-H5V'%11c_ State zip.V90
(include suite or floor)
PRIMARYCONTACT
Who should we call/write concerning this project? KwY,
Address :,553(o Rollinq 02a. city State \J'% c6l tn'%k zip
Office Phone: (1,W) *M-7 4-65 Cell #/-4 q(0q-&.A*ax# E-mail
INFORMATION
-APPLICANT
Check any that apply: _ Change of ownership Change of use. _N!!!1'-Change of name New business
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:
*This Clearance will only be valid on the parcel for which it is approved. Tf 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 bst o i knowledge. I have read the c . onditions of approval, and I understand them, and that I will abide by them.
Signature _:&A gd;,4_ Printed RdA, Guft'.4
APPROVAL INFORMATION
Approved 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 -A C Date a IV
Zoning Official Date AL_vl, oo
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 7/1/2011 Page 2 of 3
" It
Zoning to emmnlete the fnllnwinu,
Violations:
Y/
so, . ist:
Intake to complete the following:
Reviewer to complete the following:
Y / ]1
Square footage of Use:
Is us n LT, HT or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
6) / N C
Permitted as:
SP's:
Y/N
If so, List:
- — -
Will ere be food preparation? - -- - --
Under Section: - A
fir '1
If so, give applicant a Health Department form.
Clearances:
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking form
1s parcel on private well or ublic Ovate ?
If private well, provide Hea De ent form.
- --
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
-
inspector Date:
Sign permit.
Permit #
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to emmnlete the fnllnwinu,
Violations:
Y/
so, . ist:
Proffers:
YbIf
Ifs st:
Variance:
Y /f1
If so, t:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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