HomeMy WebLinkAboutCLE200800142 Legacy Document 2013-01-17Application for Z ®nin Clearance 0.F.11.
CLE # Zva -10
OFFICE USE 0N LY
�:.ZonmglClearance $35 C atc
PLEASE REVIEW ALL 3`SHEETS RecetptY# "71 LIS�i • Staff
PARCEL INFORMATION
Tax Map and Parcel 061 Y00
Parcel Owner: il'('X /�. �_/9-
Existing Zoning C ()
Parcel Address: / d%� .Gj f`� i 6 1z �• ��5� Cit, (_1 L State Zip �"� % ��
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning tjh. is project? /4i / c /��9 Airvrel
Address :/ 615 G . Add �1 •� � City ('111-IfA& State l/A- Zip���� -� i
Office Phone: C1 _7_�) # °� Fax # -�" � E -mail
I APPLICANT INFORMATION I
Business Name/Type: U2 n C,t j S CA ( C) 3 0-1
Previous Business on this site x)1,1 K yq c) Lk),,A
Describe the proposed business including use, number of employees, number of shifts, availabll parking spaces, number of
veh'cles, and any additional information that you can provide: C Al play e, e � � r7 L.;, c,,
c4 v e i C'. I e --) C� -
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature � s 1. ✓� / G �iv� Printed
W /1,9 j / 1 � r�kzin if
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`Btildmg Official, ` •� Date ` � ``'(' � �(` `
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Zorimg Official Date 0 �!
OtherlOfficial . 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
Intake to complete the following:
Reviewer to complete the following:
Y /&
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Y / 1p
Permitted as:
Will there be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies . -
Is parcel on private well public water? j) l L'
Parking formula:
Required spaces:
If private well, provide Health Departnient form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y/N
Circle the one that applies.
Items to be verified in the field:
Is parcel on septic o public sewer?
N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /M
Wilt ere be any new construction or renovations? A 0
Notes:
If so, obtain the proper Permit.
Permit #
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Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3