HomeMy WebLinkAboutCLE200800035 Legacy Document 2013-01-03Application, for
Zoning Clearance
Z
Q Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY G"
CLE # zoo
Check # 03 Date: ° —9 —O
Receipt # q b Staff.
PARCEL INFORMATION
Tax Map and Parcel: / 3 �q I Existing Zoning
Parcel Owner:
Parcel Address: q �'T Q oe `� , `d, City G K �i If State V �`— Zip -z91
(include suite or floor)
PRIMARY CONTACT n ✓ 1 �� 61 Who should we call/write concerning this project?
Address:- 3 393 �S �wovp City C (tii"A-4-0 M- y c c c State yf' Zip 1fl o
Office Phone: (µ3 2-(;, Lgyl Cell # :Lft24 - 3 5 l -' Fax # E -mail .'���5
434 qv2 tD 2_4 -
APPLICANT INFORMATION
Business Name/Type: C_ Vr--T G -t='VQ
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
a ditional information that you can provide: ))P, -I L Lb-h -1j1AJ , 3 . Z S 1^, 7 7 ^ %�X1��)
\VFN✓1 0. C7(,�op� �� ` �Gt11r —!' �G.,- L� r, k SL VLAJ y'S 1"4 S 5 %L_
*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 est of my knowledg . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed #yt om C
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, x119.
[ ] 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 " jJ Date -/ /% 0 U �
Other Official Date
County of Albemarle Department of Community Leve►opment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to c a following:
YES
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CE )packet.
❑ YES O
Will there 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
❑ YES ❑ NO
Is parcel on private well or public water?
If private well, provide Healt epa ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ,� q
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the following:
Reviewer to complete the following:
Square footage of Use:
Z YES ❑ NO
Permitted as: A,c.%S
Under Section: -2--2 - 2 - l (Z.
Supplementary regulations section:
Parking formula:
S�i j G
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Violations: Proffers:
0 YES ❑ NO ❑ YES ,W NO
If so, List: If so, List.
(:I -//3 14"4�q4s9
Variance: SP's:
YES NO ,E YES El NO
If so, List: If so, List:
511106 Page 3 of 3