HomeMy WebLinkAboutCLE201200226 Legacy Document 2013-01-02O O O
Application %r Zoning Clearance
r~Oy AL /�.
_,.
CLE #
,,,,�;,;�,�
`
OFFICE U {QTY
PLEASE REVIEW ALL 3 SHEETS
Check # 0 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: l �J Existing Zoning
4
Parcel Owner:
City 9, Ile State Zip
6A N
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
�,X S-11A City C 1 State Zip2'�
Address:
*;61'ax
Office Phone: �) Cell # �q # E -mail
3 0804
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Ic
&0us a�
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. 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.
I C l Z
Signature �A51� Printed
APPROVAL INFORMATION
—t;7f 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 �, 4" Zq /
Other Official Date
County of Albemarle Impartment of uommumty wevetopuie-
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /o
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will here be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on private well o lic water?
If private well, provide Health Meppmmnt 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 irtiblic se ?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
�/N
Permitted as:�� �6
Under Section: PA4 ; n, • �V'�! �/� -
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
If so, obtain proper I -
Y/N
Will there be any new construction or renovations?
If so, obtai the rop ftt(Q t.�Qn Permt # — l
7nninrt +n nAmnlPfP Ap fnllnWln Q_
Inspector :
Notes:
Date:
uvauaa
Violations:
/N
If so, List:
Pro f rs:
Y/
If so, List;
Variance:
Y/N
If so, List:
Y ✓,LV
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3