HomeMy WebLinkAboutCLE200800159 Legacy Document 2013-01-28Application for Zoning Clearance is CLE # OD I
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PARCEL INFORMATION /,�, �J Jl r�-� r
Tax Map and Parcel: U/ �L-• los t✓ Existing Zoning !" LA TD
Parcel Owner: I) C 91 E 136 Z
X40 WCAlerv/V76,71V .3) (z .
Parcel Address: 2J�:) 3 City .0 0' & State V A Zi p `v
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? N C14A D 17
Who
Address: It(-10 j � Cr�-121 R761v' sib 203 City ( -(qAJ- L.Li _V 6: State II
E -mail i— �kh , ke
Uh-1
Office Phone:( Cell # Fax #
APPLICANT INFO
Business Name /Type:
Previous Business on this site Rj\jA- `U L `k, -< 0 M C C--37
Zipz -L I%t
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: N�3��67�7 Fj� ULS4iZ , Z�v l NUJ S
6'v1IU &YL+ 1011PL6TeZT,- T"H&n,E' /14Z&& 20-1- P,+f cr(AJ`c(_ S:P/?-Ce& '01-1- -Ej fZ
TH-8- 141itlb (1U6
*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 oy,,gr hay the owner's permission to use the space indicated on this application. I also certify that the information provided
th
is true and accurate to,e'best ormy knowledge`. I have read -tlie conditions of approval, and I understand them, and that I will abide by them.
Signature ����. Printed j2�C1L��
AVROVAL INFORMATION
[ ] Backflow prevention device and /or current t test data needed fo'r this site. Contact ACSA,:977 74511; x1,'1'9.
[ ] 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:
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
bl�z- D3.— o r zd
Intake to complete the following:
Is/
Is ukdn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 p lic w er?
If private well, provide Health ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or Oblic wer?
Y/
Will e putting up a new sign of any kind? If so, obtain proper
Sign Prrn i t.
Permit #
Y/
Will ere be any new construction or renovations?
If so, btain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
ermitted as:
Under Section: .
Supplementary regulat' ns section:
N VA
Parking formula: 1 /)0D Apa
Required spaces:
Y/N
Items to be verified in the field:
Violations:
Y /
If so, A:
offers:
/ N
Vso, List:
C1 a
Variance:
Y/
If so ist: A
SP's:
Y/
If so ist:
A A
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3