HomeMy WebLinkAboutCLE200800127 Legacy Document 2013-01-17Application for Zonin ClearanceUF'�m
CLE # 2-006 r j T
Zoning Clearance= $35
OFFICE USE ONLY _ 7
Check# %.�15 Date: 0 t
PLEASE REVIEW ALL 3 SHEETS
_
Receipt# 1 /(j Staff:
PARCEL INFORMATION ..
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Tax Map and Parcel- P qq Existing Zoning
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Parcel Owner: }�a��
Parcel Address: l�" Wvrd_u —u -1 City ( "; Lf State Vl/ ' Zit)
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 30t DDV-C_;" Rd City a'A' IO 4�5,1 l (p State u`/ - Zip
ce V'4"
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APPLICANT INFORMATION
Check any that apply:- Change of ownership Change; of use - Change of name New business
Business Name /Type: CLJ. ' V4 ") `7 �� SLL :4CuQz. �� - �12 %Q
Previous Business on this sitei,rll`Z -�.SJ
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: 5 K a. cz- v (t -Vol VC
I TO AAC, 1 It r it t��vl�i �' 1, �� r
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify oMiove 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.
Signature pf Printed
APPROVAL INFORMATION -
] Approved as proposed' [ Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 - 4511, xF19.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennination of compliance with the existing
site plan.
[ ] This i e gomp ies with the site pla as of this date.
Notes M/i --1-9
V r ,
Building Official - Date,
Zoning Official Date i
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
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Intake to complete the following:
Y /
Is u e LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (C,ER) packet.
Y/
Will sere 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 pplies
Is parcel on privat well or public water?
If private well, pro ide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DAT
Circle the one that pplies
Is parcel on septic r public sewer?
Y/N
Will you be puttin up new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any w construction or renovations?
If so, obtain the prop r Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: _6 I d
Y/N
pp�ermitted as: 11 1AAe'
1
Under Section: 15. °� Cg )
Supplementary regulatrions section:
rn T�
Parking formula:
Required spaces:
Y/N
Items to be verified in the fie d:
Viol ons:
Y/
If so ist:
Proffers:
Y/�
If so,`Y ist:
Vari ce:
Y/
If so, ist:
SP's:
Y /pl
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3