HomeMy WebLinkAboutCLE200800131 Legacy Document 2013-01-17Application for Zonin Clearance`°
CLE # 2m8 — I
t�RC[N�P
Zoning Clearance = $35
OFFICE USE ON l a
Check # 214 V3 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # -7 Staff: 422
PARCEL INFORMATION
Tax Map and Parcel: 2, ` O D V 031 O O Existing Zoninj� I /4
Parcel Owner:
1 /
j 6 90 -y4g 51 oT-c o ko(Oi
Parcel Address: ��. �d �- State 1f Zip
—city
15r r t7 include suite or floor) /i (SUILVIAlar y
PRIMARY CONTACT
Who should we call /write concerning this project? /g- LC—XAA1 'Q&/Z F-� , Pubom 0lvr m o
559�r �lrL�; -� ii7 A� �� y 1c.Z I �Z�rD3
Address: � City �-� � State � Zi
,1 (� (
Office Phone: %( 3Y)3L310 � / Cell Vy� `""ter 2-602Fax # E -mail �A/ e64 f -7 -1 41A All
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
/n� e
Business Name/Type: (� & () % c--r I N 9 E9NA- ' 7 I i CWf, PLC
Previous Business on this site VACANT SY IT
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
-DIVA L OFFICi P_"s c113IV4 2'Cmx ',: f
vehicclles, anfd�a,�ny add /i/tio%n�a/l� info -rmati that you can provide: Me :
CIV�P•� 1...-I//i�/ ��� ���YyII�J��I�� �,A�iEN�i �clL. NoKF{ I t ���r,�,elNG-
1
SP' c 5 yal1- 013U:
*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 d he best of my knowjpdp. I have read the conditions of approval, and understand them, and that I will abide by them.
,II
Signature Printed A6&XA -N96R
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, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes
Building Official ;..�.� -- Date Ca i c�
12
Date �/G
Zoning Official
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
7'
i
A
Intake to complete the following:
Y N
Is u a I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Willa 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 /l c wate ?
If private well, provide Health ent form.
Zoning review can not begin until we receive approval from
Dept. FAX DATE
Circle the one that ap ies
Is parcel on septic or tic sew ?
Y
Will y �eputti ng up a new sign of any kind? If so, obtain
Sign pe Permit
Y/N
Wi I ere be any new construction or renovations?
If s obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: -10
/ N
rmitted as: 1 C4/
Under Section:
Supplementary regulati s�ction:
Parking fo V,/'O Q r
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
N
Date:
Viola�ti ns:
Y/
If so',�ist:
Pro le
Y/
If so, st:
Varia ce:
Y /C�
If so, � st:
Y N
so, List:
tear nr, `
SDP's / 06
Revised 04/28/08 Page 3 of 3