HomeMy WebLinkAboutCLE200800150 Legacy Document 2013-01-17Application for Zo�rnin Clearance
CLE # 2-008 ° S�
Zoning Clearance = $35
OFFICE USE ONLY
Check # / Date: 7, 5
PLEASE REVIEW ALL SHEETS
Receipt# 1 Staff.cJ'
PARCEL INFOR VtON I I Existing Zoning
Tax Map and Parcel:
Parcel Owner:
Parcel Address: ( 600 P' l 0 ! E . City MA-, 1, TfC4Vlt- L6,State t jA Zip 7-7i0f
(include suite or floor)
PRIMARY CONTACT ���y ��� Lt✓
Who should we call /write concerning this project?
s
Address:'-3-78( G—S ! �L`�Y I S City l ChM ��+w� State 4t A Zip 7-3 Z33
Office Phone: (2:�Ij 744003V Cell # (357 ) - 46-Co c # `tAq) - tddEtE -mail
(767)76.PS, 3�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name NeW bu" iness ;'
Business Name /Type: 1 I lc Le— �v� v�- (�v t P-C- LC—S S S
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 inform tion that you can provide: C'C-L -L � . to(�rfE �',a -t,�g °' SC"�t✓IcC
5 E- ctagC� 4— 71 °S!/-- ; 3 - 4 t°�—P w Dry
*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 awMedge. 111 ead the conditions of approval, and I understand them, and that I will abide by them.
Signatur / Printed L-L-Yt) /4 ",—
APPROVAL INFORMATION
[ , ] Approved as proposed [ ] Approved with conditions [ ;] Denied
[ ] Backflow prevention device and /or current test 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 complies with the site plan as of this date.
Notes
Building Official Date
Zoning Official _� „r-�s /Ki 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
Zoning to complete the following
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
11
it
Intake to complete the following:
Reviewer to complete the following:
Y / N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Square footage of Use:
Y / N
Permitted as:
Y/N
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:
Clearances:
SDP's
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y/N
Will there be any new construction or renovations?
Notes:
If so, obtain the proper Permit.
Permit #
Zoning to complete the following
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