HomeMy WebLinkAboutCLE200800143 Legacy Document 2013-01-17Application for Zoning Clearance �� °e�`
CLE # 7-6OEr` N-3 �
PARCEL INFORMATION r
Tax Map and Parcel: 2 / Existing Zoning
Parcel Owner:
Parcel Address: 2-7 �7— I _Z,S "4 p
(include suite or floor)
City 2 'S/ 1-b t't State V6 Zip 2
PRIMARY CONTACT ��
Who should we call /write concerning this project. 4-510,1
Address: 1 '1 2 b�NA Z�u r ✓. City State k Zip�1
Office Phone:(____) 2 6 �f -4 6Ce11 # Fax # � 0 / 0 E -mail
APPLICANT INFORMATION
Business Name /Type: Argue ,L� % /1/ °� J+ A -I4/
Previous Business on this site
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:
*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
Printed
[ ] Bacicflow prevention device and /or current test'data needed for this site. Contact
[ ] No physical site inspection has been done for this clearance. Therefore, it is not
site plan. '
[ ] This site complies with the site plan as of this date.
Notes:
Riril(linrs (lffirinl: �\ 'A 0, _:Q nn
determination of compliance with the existing
Zoning Official Date
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
�.. COMMUNITY DEVELOPMENTI Fax 4349724126 Jul 18 2008 11:27am P003/005
�ntalce to complete the following:
Y N
Is Ll, HI or PDIP zoning? if so, give applicant a Certified
Enginerx'' report (CER) packet.
Ti�ll Alreparation? there be `1
If so, give applicant a Health Department f0m. �/
Zoning review can not begin until we receive approval T' AAA H alth
Debt_ FAX ))ATE
U1�1.1
Circle the one that applies
is parcel oil private well or public water?
If private we 1, prl� ov Health Department form.
Zoning rcvitm, can not begin until we receive approval from Health
Dept. FAX DATE,
Circle the one plies
Is parcel septic puublic sewer?
Y
be putting up a new 5igta of any kIAAd? if so, obtain proper
Sign pennit.
Perudt #
WA Niere be any new construction or renovations?
If so, obtain the proper Pa -mit.
Pemit #
7.nnina fn rnn-nh-+ +ho MYti`AVVitY6!
to complete the following:
Square footage of Use:
Y /N•
Permitted as:
Under Section=
5upOcYummy regulations section:
Pazking formula:
Required space$:
Y/N
Items to be verified in the field:
lospectok : pate:
dotes:
Vzodations:
Y
If so, List:
Proffers:
Y/N
If so, List:
Variance:
y1N
If so, Dist:
SP's: .
Y/N
If so, List:
ClesrsAACes:
SA1"s
I
Revised 04/28/08 Page 3 of 3