HomeMy WebLinkAboutCLE200800146 Legacy Document 2013-01-17Application for Zoning Clearance
I*—
CLE # O � - I Co
OFFICE USE ONL
-7-2-09
Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS; :
Receipt # Staff:
PARCEL INFORMATION n
Tax Map and Parcel: 01c700 - 06 "Q0'- 0/70 0 Zoning / -
T
/ .,GExisting
Parcel Owner:
Parcel Address: ",44;v 21city C�,14e/ fd- /� State Yf 22-.92 4ip
(i clude suite or floor)
PRIMARY CONTACT
Who should we call/write cocerning this pro' ct?
Address: 30/o a,,'/,'/ �
Office Phone: ((� %3',z YS/L- Cell # Fax # E -mail C, i,-0 z cr 1S a.,..
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: L.•,!?�� IL C_ /f
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spac , number of
vehicles, and any additional information that you can provider oo - rAwt -- / �; 3o 'P:�.
*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 t the jest of my kno a ge. �e read the conditions of approval, understand them, and that I will abide by them.
aX11z1X.,7Cz
Signature L �_ ( /!P_ 5 Printed L441S
APPROVAL INFORMATION
[ ] Approved as proposed [ Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current tot data needed for this site. Contact ACSA, 977 -4511, x119.
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 com lies with a site pl as of this date. . --
Note s•
r L -�l
Building Official Date y
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
Intake to complete the following:
Is
Is u m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y "ef
Wi e 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 we , pr`11 —ro Realth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE.--7—
Circle the one that applies
Is parcel on sngticc r public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit. '7
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obta' th pro a Permi
Permit # r
Zoning to complete the following:
M
Reviewer to complete the following:
Square footage of Use: 1,1, % 6 `f
$� I N t tr J-L�(
rmitted as: I C (h l
Under Section:
Supplementary regula ' ns section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
2 1, "FW'FME/1M;1' / I
bez �-
Viol ons:
Y/
If s2ist:
Pro rs:
Y /�Nv
If so List:
Vari cc:
Y/
If SOP, ist:
SP's:
Y/N
If s,-, Li t:
07 -' It, 4 l� c�oCeQyc.
-t-a ar"0 5-f-G�d
Clearances:
SDP's
l
Revised 04/28/08 Page 3 of 3