HomeMy WebLinkAboutCLE200800108 Legacy Document 2013-01-16Application for
Zoning Clearance
S
OFFICE VSE ONIL Y
Zoning Clearance = S35 CLE # o ab t69
PLEASE REVIEW ALL 3 SHEETS Check # Date,
Receipt # C1 Staff: ��✓ .
PARCEL INFORMATION
Tax Map and Parcel:
L•15/ot IA
E�istingzon�iaa� C- ammu��«�
1'arcelOwner: +rAac ��-C-
i�a�`��r�'S
Parcel Address: 6 I Wond6raoiC_LCr. S,)A,-ti City G1ncirlo4AesVi'Ile, State VA Zip aa°lol -1141
(include suite or floor)
PRIMARY CONTACT
Wtio should we cnlVwrite concerning this project? M i c1Xr 1 iC, z4a -1TE C. V i rq ► h i q LL_C-
Address : (n IS Wuod6YOo1L- g City Chart°- i -ks_�i 11c State VA- zip ';�aolol II`{`3
C-i3Li
Office Phone: ('i34) 5'o097 _Cell# )Fax# 0115'04-1 -1 E-mail
X 5go t Drn
APPLICANT INFORM.A.TION
Business Name/Type: -M(y V x' fco t 'I a L.-L-C
Previous Business on this site L.ov%nv ioh vj --a..L f��P rai 5a.� Co�rporu� -%�o.1
Describe the proposed business, including use, number of employees, number of shifts, Available parldng spaces and any
additional information that you can provide: we. otes%' r^ 0-eA nor,ol.Uc'+ dtV't ca 1 -b-4a-IS v- p1\a,rnnaC -r-L4; cc
Covnpartit5 , ;^r-luAkv cq ala-4a j2Mor-6v%ci . 'C[�we cue. 5 C.-nploLyices .
*This Clearance will only be valid on fbc parcel for which it is approved. If you change, intensify or move the use to a new location, anew Zoning
Clearance will be required.
I hereby certify that 1 own or have the owner's permission to L= tiio space indicated ou this application. I also certify that the infortration provided
is true and accurate to the best of my knowledge. I have read the Conditions of approval, and I understand them, and that Twill abide by them.
Signature '�V�N �u -e-Q-� S �i^-Q •^� Printed M i cl�a lip- Scl� 1 r s i r, qc.✓
APPROVAL INFORMATION
[ ] Approved as proposed [ Approved with conditions oni
[ ] Backflowv prevention device and/or current test data needed for this site, Contact ACSA, 977 -45 1, x �c ow Device and/or
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a deternunation f GgamteRst sl' ed
site plan. Contact ACSA 977 -4511, x 119
[ ] This r �xi lies with e sit 1 as of this date.
Notes; "!i(�'. �l 64-r . t2A F— AL2G A L-4 or4A—rb e\-t1
Building Official - Date I (f o
Zoning Official Date s 2.8 � g
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
511106 Page 2 of
E00 /ZOOd 1dVl!Z0 800Z ZZ add 9Z PUREV Xud UNINd0lIA]a AlIN moo
Intake to comp ate the following:
❑ YES NO
Is use in LZ, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
❑ YES ET�O
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval firoxn Plealth
Dept. FAX DATE
❑ YES ❑ NO a`-a Is parcel on private w6l or p bIf private well, provide Health ent fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or tblic sc or?
❑ YES ❑ o
Will you be pu -ng up a new sign of any land? If so, obtain proper
Sign. permit.
Permit #
❑ YES I NO
Will there be y new construction or renovations?
If so, obtain the proper Permit,
Permit #
Tech to coi6lete the
Violations:
❑ YES [DINO
If so, List:
Variance:
❑ YES 0 NO
If so, List:
Reviewer to complete the fo lowing:
S uarc {{{dottc6c of Use; �Q�
9 j b
Q YES ❑ N
Permitted as: Act/
Under Section: 'R�- oz. I
SupplemenTary reg lations section:
1/1'11 d
Parking formula:
Required spaces;
Li YES II No
Items to be ven'fled in 16 field:
Inspector
Notes:
❑ YES
If so, List:
Date:
S':
YES ❑ No
If so, L�ist&
511106 Page 3 of
600/600d WdVI!ZO 8002 iZ add 9ZLVUMV xa� UNIUIIA30 AlINI1WWoo