HomeMy WebLinkAboutCLE200800134 Legacy Document 2013-01-17Parcel Owner:
Parcel Address: F-AS� 0 kcC City ���1 IV/,' State Zip ") o
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 600 E_G!A k t h �_ _ � City C YY V� 1 q State ��i Zip o!o1 "� /io I
Office Phone: �7� °�� Cell #f� ��J9 -��5� Fax #1�N��'�3 �737J� E -mail �{p��1Q5r�y,6'caEfP6��f
APPLICANT INFO
Business Name /Type: A Q S 14t
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available spaces number of
vehicles, and any additional information that you can provide: P) _1011 L , AV 61 IECA
*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 certi• rat I own or have the owner's permission to use the space indicated on thus application. I also certify that the information provided
is true and accurat to the best of my kn ledge. I have read the onditions of approval, and I understand them, and that I will abide by them.
Signatur' ( Printed f�, ( " � � l.l�C() ec(
[ d 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: _
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
0-041
Intake to complete the following:
Y/N
Is use i LI, or PDIP zoning? If so, give applicant a Certified
Enginee eport (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 DATE
Circle the one that applies
Is parcel on private well or u�water9 If private well, provide Healt orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap l:
Is parcel on septic public sewer.
Y
Will be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will 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: 3
Y/N
( �,
ermitted as:
r t pr\ all
1
Under Section:
,
Supplementary regulat ons section:
VL �
Parking 154wp '0
Required spaces: --p sk E-OM / Y kwfj
Y/N
Items to be verified in the field:
Viol 'ons:
Y/�
Ifs ist:
Prof rs:
Y/
If s ist:
Var' e:
Y JNJ
If ist:
N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3