HomeMy WebLinkAboutCLE200800125 Legacy Document 2013-01-170
Application for Zoning Clearance �_� ��
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Zoning- Clear
TT T A C T1 TES TTT SS7
PARCEL INFORMATION
Tax Map and Parcel: vJ Existing Zoning
Parcel Owner: QQ•' �
Parcel Address: ncss RiQ �'� �� Ul City(�� 7i�1� State \1A Zip
(include suite or floor)
PRIMARY CONTACT ;.
Who should we call /write concerning this project? nv_tii�
Address :� �� o' -e�?�) �,��x . I cti-C City !�4v– 1 State M 1^ Zip,' e4q4
Office Phone: Cell # Ur ,` qO -'361 iax # E -mail
APPLICANT INFORMATION
Business Name /Type: ��� Y\/"� C��U V r� �� �'''� Sic S SLn)
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parki g spaces, number of
vehicles, and y additional information that you can provide: � ,(� 'IDO �t e-tS
*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 percussion 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.
Signature %J Printed DpP1 -;kA —)
APPROVAL INFORMATION
,kTApproved as proposed [, :, ] Approved,with conditions; [ ] Denied
] No physical site inspection has been done for this clearance. Therefore; `itis not a determination of compliance with the existing
site plan.
[ ] This site complies mith the site plan as of this date.
Notes:
Zoning Official Date 6 // //L) 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:
Reviewer to complete the following:
Y 10
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
\Y )/ N
Y
�tiere
ermitted as: ! ►9,
Will be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Clearances: )
Circle the one that applies ... - - ��
Is parcel on private well public wate
Parking formula: ` �
o 1�
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y
Circle the one that applies
Is parcel on septic or4b 1;1?
Ite e verified in the field:
Y 6)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y //*
Notes:
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viol tions:
Y /
If so, List:
Pr ers:
Y
If so, ist:
Variance:
Y/N
If so, List:
SP's:
Y�1
If s` , ist:
Clearances: )
SDP's
Revised 04/28/08 Page 3 of 3