HomeMy WebLinkAboutCLE200800123 Legacy Document 2013-01-17Application for Z®nin Clearance 2`
CLE # 100
"4iCINP
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
City ���=�0/® M'dte Zip Address 5eO //7 1>7
Office Phone: Cell'7 "��� # / < a��/ );- mail ✓� // ��t'r2 �l�
APPLICANT INFORMATION I
Business Name/Type: / //I / ly'�j U��+G�J �L /�vJ
Previous Business on this site
Describe the proposed business including use, number of employeeu number of �s�hifts, available parkin spaces, number of
vehicles, and y additional informatiollhat you can provide: 4.,e7�, (o(. Ak ii�4 J� Z�C
-3 kLU
*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 c i a I own a the o s permission to use the space indicated on this application. I also certify that the information provided
is true and u 3 e. I have read the conditions of approval, and I understand them, and All ilha Me by them.
j / ��
Signatur Printed (>�� � � �
an _
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.
Y/
Will ere 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
Reviewer to complete the following:
Square footage of Use: (go
ennitted as:
Under Section: 0
Supplementary regulations section:
Circle the on s Parking formula:
Is parcel o private well public water? r
If private w , e ealth Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the plies
a
Is parcel septi __,c,6r public sewer?
Y N 1'
W u be putting up a new sign of any kind?
Sign permit.
Permit #
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
1, Notes:
W re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violaf ns:
Y/
If so st:
Proffers:
Y/(
If so;2 st:
—4
Varia e:
Y/
If so, ist:
SP's:
�/N
11065-
Clearances:
SDP's
Tit J
Revised 04/28/08 Page 3 of 3