HomeMy WebLinkAboutCLE200800093 Legacy Document 2013-01-11Application for
Zoning Clearance
e� nrr3E,
Zoning Clearance = $35
OFFICE USE ONLYO �ry _ p
CLE # 0 / 3
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
7 Staff.(Jl,
Receipt #'7p
PARCEL INFORMATION
' /
Tax Map and Parcel: T O & Existing Zonin g _
Parcel Owner: rONV5 Fi14P LLIi
12H I P'tcoAnvp P-D City CMJ21,oTr93V16(' State I'A" -Zip-
Parcel Address: p -
(include
(include suite or floor)
PRIMARY CONTACT -tea f✓
N NIFZ,
Who should we call /write concerning this project?
Address: ZZZ E. /W fN ST hj� ty ?50City GW(z G yT05VQ 'ate V*t- Zip Zia Z
Office Phone: (k3�) �6l-7$5IZ Cell # �3g?W VIF x# N E -mail o(anr�l. soda �/
h.6. Co r✓�
APPLICANT INFORMATION
Business Name /Type: VKONlq /vAT IONRZ "MA14
Previous Business on this site /1' OOPF S Gl/M -gC %Z
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: BolLtA16 &rr-vF.-, ',P V v4Ripu6 8ANK BMW
oG Fi4r SmAFr, AMOX 63 57ftFF TAl— ! T ark ''-' H /FT
I Os tF- 6i 4- 5 N r oD� 1 d 3r qge Q�
NA ,Yjj 1�L ��vh (!5 117(954/ 50 r
*This
Cleara ice 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 no dge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature Printed DAN lr2, P 6a1) DA4l;L�-
APPROVAL INFORMATION
as proposed [ ] Approved with conditions [ ] Denied
rlApproved
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 deteiniination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official " Date 3
T� S
Zoning Official Date 9
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to complete the following:
❑ YES ] NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) pacicet.
❑ YES NO
Will there he 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 Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
ES ❑ NO
Is parcel on septic or public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any rind? If so, obtain proper
Sign permit.
Permit # 01— 2 5V -S Q 7 �S 1---
11 Tr YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # /; �'--
l een to commete the
Violations:
❑ YES ,W] NO
If so, List: kA�� AM&
Z Va •lance:
YES ❑ NO
If so, List: �P-3 (} 1 n
Reviewer to complete the following:
Square footage of Use: � 2,
V YES ❑ NO
Permitted as:
Under Section: C
Supplementary regulations section:
Parking formula: AWr' v j
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
511106 Page 3 of