HomeMy WebLinkAboutCLE200800137 ApplicationApplication for Zoning Clearance =� " °�iL`�9
CLE # _2009—/,--3 % ;� A��,,�
� "�RGIN�P
PARCEL INFORMATION
Tax Map and Parcel: 56, r I - I O-Ket 56 r; I - Z Existing Zon'
Parcel Owner: ClDU'r-►'' �avJh
Parcel Address: 375 Fc)LLr- fee j Lan-c city Cha. ,- loftSv) lie- State Vlre jnf& zip z2!-
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Ber4vn bvviner-
Address :`��'q �,.S+ lVl&P k__4 s4, -ee-4- CityC4ULr1DYeSVi Ile State Zip
Office Phone: ( 3q)M (P "655/ 5 Cell # Fax #2-c ' C-I 125 E -mail ben4w' P G1Dwrw,-and aSSC
I APPLICANT INFORMATION I
Business Name /Type: 61R-f_ Ridoe. l nl Ser V
Li
Previous Business on this site /VOU - NZbJ ar)S4ra t. - On
Describe the proposed business including use, number of employee number of shifts, available arking spaces, number of
vehicles, and any additional information that you can provide: � u 64 �ti 0Oi1- �'y��ri� " n,;i, LVA',_tt P,nust�Lkj
�i101i_ea1V4AtLot'46I 6 ,4117 -k hr` MiM&%,rfth• h."y ay /l �( '44"b4ya°lY!/9 /�1� °•I liIc /�.4 ^�k/ ✓elV!rf7�i�oOl+yUyi
all 1Q I�Q AAAAi — UZ+t arZ LC.,. -A lr19/�tr Nn.rt e.S OCe4,I,0,.t. !J a wh!>I — /li PL yG -,y-9 #Cti.I�.! rZy�ws Wt f -dk)
*This Clearance will only be valid on the parcel for which it 4s approved. If you range, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that �tle or hav he is permission to use the space indicated on this application. I also certify that the information provided
is true and accuraye tbest o i y ow�edge. I have read•tlie conditions of approval, and I understand them, and that I will abide by them.
FL1__% /"
Signature L �L -1 SM /r Printed Imp D. 6 6,e,��
[
']No physical site inspection has been done for this clearance. Therefore; it is not a determination, of compliance with the'existi
site plan.
[
]This site cornplies 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
(40 5 .
C'.o i-n
Intake to complete the following:
Yt / N
Is u ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /N�
Will t 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
Circle the one that applies
Is parcel on private well or public water?
If private well, provide 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 septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. / j Q
Permit #
Y/N
be any new construction or renovations?
.n the proper Permit.
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: - I E
Vr N G&
•P rmitted as: }� 1 j
Under Section: ��A , c � ' l
Supplementary regulations section:
Parking formula:t��b
Required spaces: (of a r�
Y/N
Items to be verified in the field:
Inspector : I Date:
Notes:
Viol ns:
f / n '
If so,
Proffers:
/ N
I so, List:
Vari nce:
Y11
If so, ist:
SP's:
/N
so, List:
Clearances:
DP'
Revised 04/28/08 Page 3 of 3