HomeMy WebLinkAboutCLE200800109 Legacy Document 2013-01-16Application
for Zoning Clearance
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O ZoningClearance.= $35 .
PARCEL INFORMATION ' d _ l a
Tax Map and Parcell:` L. W ` Existing Zoning ii�`WX
Parcel Owner: �„J 1"� i � � C V (Z-vIi 0-1R.
Parcel Address: 1A L r eO City 0_�o y ��,t�., State h Zip
(include suite or fl orr " "I',-
PRIMARY CONTACT
Who should we call /write concerning this project?
.� e r
Address : W �� �s�� City , V k k-L State V Zip I o
Office Phone:( �� - 6! ell # Fax # E -mail 6e Lr v- 4'k 11
I APPLICANT INFORMATION I
Business Name /Type: G U
(ZAL � X) V C> L' � cr't'L. 10c,
Previous Business on this site 1► ��� "> �.• :� u Pei— i1
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional infor nation that you can provide: jO_e:�M,i1���
G� � P�ak2� �t.?C� 'fi � lt�-L� � 16�iic. •'I" � � �.
*This (!1earance will only be valid on the parcel for which rt is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify th I own or h the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur o the bes o myrdge. i' e read the conditions of approval, and I understand them, and that Iiwill abide by them.
Signature Printed 6 ,1L.. � �• e-ocic•
APPR AL INFORMATION
[p Rfoved as proposed [ "] Approved with conditions
[ ] Backflow prevention device and /or current test data needed for this site. Contact AUL A, 9 ce and/or
J
No physical site inspection has been done for this clearance. Therefore, it is not a det' ri�ty��oliv}1}ist lg
site plan. Contact AC5A 977 -4511, x 119
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date I j
Zoning Official ✓� Date d
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 04/28/08 Page 2 of 3
Intake to complete the following:
Y1
Is u e n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil here 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 or p blic w r?
If private well, provide Health a tment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic ublic sewe ?
ill u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
WN there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the ollowing:
Square footage of Use: Ob
Permitted as: oF,4C.J2,
Under Section: Q
Supplementary regulatio s section:
A 01
Parking formula:' /06 6 4q
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol o s:
Y/
Ifs st:
ffers:
N
so, List:
UI 4,U d
Vari ce:
Y/
If so, ist:
SP's•
Y/
If so, ist:
nces:
SMFP s
Revised 04/28/08 Page 3 of 3