HomeMy WebLinkAboutCLE200800138 Legacy Document 2013-01-17Application for Zonin Clearance
CLE '#
t' /RC;INIP
❑ Zonmg Clearance = $35
PARCEL INFORMATION ✓�
Tax Map and Parcel: — ;lam_ Existing Zoni:
Parcel Owner: O XIVC "r�
Parcel Address:�ly IVY RA fa ITE od 0 City UAX L,6 flSJV /'hafe
(include suite or floor) 1314)A)J1.&e ",o!'W I,
PRIMARY CONTACT
Who should we call /write concerning this project?
Address
Office Phone: U Cell # _
City State _
F xV E -mail
i,u) Aal q)
K4 Zip ;42 `j(I
Zip
APPLICANT INFORMATION I
Business Name /Type: MOMCAIT4ni PIt-ArES - (F1401ea 161TAIEfs feX I(I&E
Previous Business on this site f,1 A4 F - N ti✓ d 4) A) 2 /2 �-Sb 1 °�Q P� / �!J
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: SEALll e, P IWFS5 (PI 1-41-611f ) , f vw a E4
1A1,0 EP Le Al rAA 6"A,( / KC11 l (, Gt PER. Slf !F?' FAR 80A IEEQ a- f" Q 9*,b FN
UA.fSES 3 !/KS pEe OA I 9- /u * IAI lz:dd PM t S7,Y0 -� 3l P14 M 7- #1/es,
*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 to the best of my know ge. I have read th conditions of approval, and I understand them, and that I will abide by them.
Signature Printed y C %� k 1V JB N - Q 16 % �
ed as proposed
[ ] 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
Intake to complete the following:
Y/
Is us ill" I, HI or PDIP zoning? If so, give applicant a Certified
Engi eer's Report (CER) packet.
Y/
Will her e 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 pp lic ater?
If private well, provide Heap D partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap 'es
Is parcel on septic or ub i sewer?
Y/N
Will you be tting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # ff j
Y/N
Will there be any new construction or renovations?
If so, obtain th"e)proper Permit.
Permit # •f
Zoning to complete the following:
Reviewer to complete the following:
r
Square footage of Use: Jd
rr ted as:
Under Section: -9—
Supplementary regal i is section:
Parking for a +�a: _
Required spaces:
Y/N
Items to be- verified in the field:
fW
/v V U
Inspector : Date:
Notes:
Violations:
Y /F�
If so, 1st:
Proff r :
Y/
If s �, List:
Varia ce:
Y /(
If soy st:
SP's:
Y/
If s 'List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3