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HomeMy WebLinkAboutCLE201200178 Legacy Document 2012-12-19Application for Zonin learance- 1' "`'4� CLE # PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLYr,`S� Check # e: Receipt # Staff: PARCEL INFORMATION tt� nl /� a 1 o C�Q�j Zoning Tax Map and Parcel: W / � �,� Existing �LJ (� Parcel Owner: ►"r` Parcel Address: 0 UyiLr ' .City l — �/�1 1. V State �� Zip (include suite or floor) PRIMARY CONTACT j,Q� T � 61OZ QXU Who should we call /write concerning this project? �I� ` Y l(/�, (\ 4l c� `,, Address: () b tJ b 'i'��1� �(� Ui ILC � City State Zip 1. Office Phone: U Cell # Fax # E -mail c 6 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type:I ���i�'► ��.CJ I Previous Business on this site Describe the proposed business including use, number of employees,/ number of shifts, ava lable parking spaces, number of vehicles, and any additional information that you can provide: 1`YS 21 *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 Printed APJDROVAL 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 CZ� -j r f t Z Zoning Official Date I�J 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 ,0 Intake to complete the following: Is/ Is use n LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified � N `gill there be food, eparation? If so, give a scant a Health Department form. ZonkW,Kiew can not begin until we receive approval from Health Dept. FAXDATE- /IAI'�j1L��, -'(�( Circle the one that applies Is parcel on private well of ublic water? ` f� If private well, provide Healt ment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that lies Is parcel on septic r public sewer? Y/N Will you be putting up a new sig of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any ne construction or renovations? If so, obtain the pr er Permit. Permit # Zoning to comDlete the following: Reviewer to complete the following: Square footage of Use: a SM [fitted as: 1 K l)�.1�� Under Section: Supplementary regulations section: Parking formula: Proffers: If/N If so, List: Required spaces: W verified in the field: Inspector : —M 1- , A Date: Notes: IS11 -d' Vio io . s: If s ,�st: i � Proffers: If/N If so, List: Varia Y/ If so, 's: Y/N so, List: Clearances: � � � n SDP's r Revised 7/1/2011 Page 3 of 3 ./ / % k ƒ .> \ 0 S \ _ U) § k / IM, \ � .) / 2 0 k ± u \ c a ± � / N 0 9 R E & / »» #\ # \co22 /m»¥ 7 5 ƒ D G 0 \$ \/\ 2 0+ 0ƒ E 7 J / a /) f 2 < / § a) \ 0§ e e %±- o = o a Or- /± ƒE ƒLL / / -2 \ / / 7 / © 0 § E / o r ° oe \\7� (D + 0 e % %we o w r) ± n o = \�.$\ / \ /0 _ & n % o 0 @ _ .o = _ / /_ / \ / 2 \ G 0 / » 0 § e c = E ® \ \ m 0 \ \ / o % 5 0 0 $ 2 / _ (D - a a) / - E / )o a \ _ \ ® � %/ �\ / / % $ / / p \ / O [I- w 0 0 0 0 0 0 0 0 0 0 0# &o #oro&00000e&oer 2 ore# \ \ \ / / % / /% \\%% U) r r r o ®* 2° o o= 3 ƒƒ e- 2$\ n$® 2/ o f cn f e 2 e= 2 2 0 0= E e o e< s e g o \ \ � \ / / / / \ % ( < Co / / 06 CL CL .$ C e m g\/ 2$ k/ n@ m¥ / = 2 2 5 2 2 e=> E » 2� L I_ e m 0 /// \ §a�} \� / cE= < \/ \ ƒ O n ee e / 22 e -- 2 O = E / / 0 g / f < 2 =O�cUI <LijCa / / e / / / / / $ ƒ / $ 2 r rmmrrmm�CY)(Y) \ � .) / 2 0 k ± u \ c a ± � / N 0 9 R E & /