HomeMy WebLinkAboutCLE200800116 Legacy Document 2013-01-16Application for Zoning�
4-0v e klearance CLE #
PRIMARY CONTACT
Who should we call /write concerning this project? G -PU—
Address: 16,11 & Cc it ST. City [ CState C` Zip Z,
Office Phone: ( �i� IQ�jS Cell # ^91V" Fax # E -mail nn�ss�n Lt��.Q�
APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site 1) /)R-
ai 'sQAffn
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: 5ee %4 G silo- -
*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.
SignatureCC.hI°t4.�! �. c•1�A1 Printed "Ch aQ G l (Z�Gk.,)
Arrlty v rli, u 'N r vtuv1111 1 iviv
[ ']= Approved as proposed [ pproyed with`
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 /a
Is use in LI, M or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/&
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 DATI;%J�-�/
Circle the one that applies
Is parcel on private well o up blic Ovate
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 applies
Is parcel on septic o ublic se r?
Y /aN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / 'I
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /loll-,
Q l
e erlit �.P/f qy mitted as:
Under Section: ArO6"14,- D k22 Ch C,t
Supplementary re u }ations section:
d
Parking formula:
Required spaces:JC�.
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violati
Y/
If so'—, fist:
Proffers:
Y /14
If so, List:
Variance:
Y9
If o, ist:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3