HomeMy WebLinkAboutCLE201200245 Legacy Document 2012-12-14Application for Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
1,66 —3
OFFICE Y G
Checic# Date.
Receipt # Staff: rfvV
PARCEL INFORMAT, N't�� hh ��nn//�� �j� p n'
Tax Map and Parcel: �� 62 ` yU��."QJCJ Existing Zoning l,Z�!'lril ao n
Parcel Owner:
Parcel Address: lCkk{ ! �ti City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? C �rb\,�i S�D�
Address: 11 Ds '�VdC) s� • Cityc 1, la'('IAU k State V iY! 1162k Zipzzg0
Office Phone: 2 Sq Cell # 1 Fax # E -mail CA(10\f) SY) bW 0 S'Il OW KY Dw
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
snpw-5 Business Name /Type: l'Jax&o Q I of IZ n n
Previous Business on this site ComN zlc6a` 1c� ftK Salt,
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: CbrOyf aS 41-? 2 2YY1 �o
C69- 2k-m i orne Y Iri yz m �o h
*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 ead the conditions of approval, and I understand them, and that I will abide by them.
Signature 1 Printed
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 Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Deveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following: I Reviewer to complete the following:
Y / N Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N %
ermitted as: `i %nr'�
Y
WiQtere be food preparation? Under Section: d-A � , A�';�
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 tormula:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE i— 1 a
Y/N
Circle the one that applies Items to be verified in the field:
Is parcel on septic or public sewer? �� a
S
Y / N appl�/ Vc �` t-, )
ill you be putting up a new sign of any kind? so, obtain proper
Sign permit.
Inspector
Permit #
Y /^ Notes:
Will�1T`i'ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7 .. 4. .,1 +o +h fnUnXxrinrt0
Date:
..... _ -- ---- ---- - - - --
Violations:
Y/9
If so, List:
Proffers:
Y
If so, ist:
Variance:
Y /
If so, List:
SP's:
Y/(
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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