HomeMy WebLinkAboutCLE200800147 Legacy Document 2013-01-17Application for Zoning Clearance
CLE #
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$35
OFFICE USE O 01 Y
'Checlt #! Date: T' j�'�%
Zoning" Clearance =
PLEA REVIEW ALL 3 SHE, ETS
; Receipt # ' 7/5401 Staff:
PARCEL INFORMATION Q q (�
0 — J Existing Zoning
Tax Map and Parcel: /
Parcel Owner: /� B P D C" r r
I
Parcel Address: 9 Z sh ° CaU�` ity v` , ✓/ State y Zip2 Z ��
(include suite or floor)
PRIMARY CONTACT
b /M S�2 0 LJ
Who should we call /write concerning this project?
Address: .S� O w 5 �% U n Sep City State Zip
Office Phone: U Z t t t Cell # 3` S$ b f Fax # E -mail
APPLICANT INFORMATION
owneship;..` Change ofuse , ; Clt'ange of nairie New business
Check any th "at'apply ., "Q f,
Business Name /Type: S le s, y 1 C'25 %AV PC—
Previous Business on this site U cl�
I
Describe the proposed business including use, number of employees, numb,
vehicles, and any additional information that you can ACV (
*This Clearance will only be valid on the parcel for which it is approved. If you change,)
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on tli t�
/
is true and ac ate to the best of my knowledge. I have read the conditions of approval, a�� V%
Signature Printed
i
APPROVAL INFORMATION
[ ] Approved as,proposed [ . ] Approved with =conditions
[ ] Backflow prevention device and /or current test data needed for this site: Cont
] No physical site inspection has been done for this clearance. Therefore, it is n1
site plan.
{ ] This site complies with the site plan as of this date.
Notes:
Building. Official Date 'ir A -n
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:
Y/N
Is use i QsRTport or PDIP zoning?
Engine (CER) packet.
Y gtlj
If so, give applicant a Certified i
Will there 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 o u�epartment
If private well, provide Healt m.
Zoning re view can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer.
Y/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
[Y /N
ill there be any new construction or renovations?
If so, obta'• tj�e�p�ri4pe eM 't.
Permit # a,F3'J�j
Zoning to com lete the followin :
Reviewer to complete the following:
Square footage of Use:
Y / N
Permitted as: l�y r� � ✓mss ��""
rr
Under Section:-
Supplementary regulations section:
Parking formulae /,-�)'e +
Required spacesg n &
Y / t(�N �
Item�-to be verified in the field:
Inspector : Date:
Notes:
Vio�• ti`ons:
Y /�)
If so, lst:
PrYL rs:
Y
If 1st:
Va r q ce:
Y/
If so, st:
S s:
/N
so, L 9t'0044.
Clearances:
SDP's
SDP's
U�f M J'"
Revised 04/28/08 Page 3 of 3