HomeMy WebLinkAboutCLE201200262 Legacy Document 2013-01-11MUJA a6 L6 iii' 64GMCA
Application for Zoning Clearance
CLE # .701 �_ `2bZ
OFFICE US Y
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: yrymOO
PARCEL INFORMAT//I "O" SS � n�
Tax Map and Parcel: lt� t L� Existing Zoning f 7�to wl WY
Q,t b A�66y`a+es
Parcel Owner:
Parcel Address: 1JL ,8ErnA2cF c5 Q• City ONA 9LoTTESI/1LLEState V")} Zip x0,701
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 5 H A P 0t3 lit) N
Address:/?,2/0 1- 44e,4SlE✓C, ffay. City d /- /,14L'o %C State NJ Zip c2y.� 7"/
Office Phone: 33a a 9 ell #7oq&07oo6'& Fax #'7o Y'75a39o8 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /77 /�?!f G L[r - �Q R_ GAG- /V 7_277 2
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: J g. Q wp.e u,Fe.ea
0,4ka 4eh_,�
*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 08 & P_,0 A; 14 4o i PK & y
.
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 ( �L
Zoning Official >,k 41 Date
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
STORE, STORE f, 6 ADDR. PLANNER APPROVED AS NOTED -
SHAWN MANNINSI HAVE EXAMINED THE DRAWINGS THOROUGHLY A
D MIRACLE -EAR 763 -268 -4442 APPROVE [IF ALL LOCATIONS, DIMENSIONS,
g ALBEMARLE SQUARE DEPT, SQ. FT. SPECIFICATIONS, AND NOTES ON PLAN.
S CHARLOTTESVILLE, VA 950 SQ FT SIGNATURES DATE
z DRAWING DATE TELEPHONE 41
11 -14 -12 )ESIGN BRAVING NOT TO BE USED FUR CONSTRUCTIO
Pktl�3 11/23/2012 1222 PM fk OaM wAk 11 -23- 2012499
Intake to complete the following:
Y N
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil ere 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 • ubli
If private well, provide He t1nDorm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
r Isparcel on septic public sewer? /N
mill you be putting up a new sign of any kind?
Sign permit. o J� _ n ) � I
Permit # �
If so, obtain proper
N
In there be any new construction or renovations?
If so, obtain t proper Perini
Permit # `s
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: I V
Oer:itted as:
Under Section: !1 1 )
Supplementary regulations section:
Parking formula: P DC
Required spaces: 4
Y/N
Items to be verified in the fiold:
Inspector:
Notes:
Date:
Vio ons:
Y N
If s ist:
Proffers:
Y/N
If so, List:
Q
Vari e:
Y / N
If so, List:
SP's:
Y / N
If so, List:
q3 .
Clearances:
SDP's
A,L
,L
f! = — 39-
Revised 7/1/2011 Page 3 of 3