HomeMy WebLinkAboutCLE200800107 Legacy Document 2013-01-16Application for Zoning Clearance
CLE # 2069 60 (6
OFFICE USE ONLY
0 Zomng Clearance '$3S Check #
Date %
PLEASE REVIEW ALL 3' SHEETS ' Receipt # `0 °Staff.
PARCEL INFORMATION _
Tax Map and Parcel: L`d l '") �� `��- Existing Zoning tiC
Parcel Owner: ✓
Parcel Address: S �') �� (, I G H Y)O N O C City C10 t Z [ j //State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address
1 b b �"_ Co i jP ) L P1 )A 10s City c, 14 (3(LLaV l
Office Phone: L� ��3 "7 7 Cell # -�� Fax #
0- L- 00E-Z
State V 9 Zipzz - /)
E -mail
I APPLICANT INFORMATION I
Business Name/Type: V' D L j
6) (L a
Y I
C
Previous Business on this site I N'
L�
.j G L
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: (, C-S-J i �L P vL L -j 7 Z�
Q Ga 21G , n G H-2- Get Y- S f Z i-' rj' N l7 ( f z /,7
*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 b t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Sig c Printed C-g L. O �� Z
II I
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YJ/ N
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
Circle the one'that applies
Is parcel, on private well oGblic- wat�
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that p
(Is parcel on septic o o public sewer
Y /'N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. _
Permit # 0
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit
Permit # 0 1� 1- ) L t
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use: V�
Y/N '
ermitted as:
Under Section: a ,
Supplementary reguli4tions section:
AL a
Parking formula
Required spaces: �-•• (_ I", s� 'I AO r
Y / N dJ -�►��
Items to be verified in the field:
Inspector :
Date:
1, .l
nw� •, .,...., « ill
�. -
�,.:� 1�
Violations:
Y
^ I — n10 If so, List:
Proffers:
Y
If o, 1st:
Varia
Y/
If so, List:
N
T
If so, List:
47
'27
Clearances:
SDP;et 06 y + 2 ✓/ l /�
Revised 04/28/08 Page 3 of 3