HomeMy WebLinkAboutCLE200800160 Legacy Document 2013-01-2808/07/2008 12:13 4349514202 LAURELS OF CVILLE PAGE 05/06
.A pplic fl n for Zoe "1. Clearance
iCLE # - C20
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Tax Map and Parcel: "" Existing zomiln
Parcel Owner: J 7
Parcel mddress:�(l� City l �' State zip
(include euite or floor)
PrA>RY CONTACT
nill�Pr Yom. -�'i
Who should we cut) /write concerning this project? I r(
Address :)o City�V� 1' Skse¢c � _ Zi
Office Phone: (_, Ce ## ox
APPLICANT A�T&'OR ATION
Chamlk ia' i[ketaP6 'i> m w l '> �oaJJa�� ail r�i - ,�; eal_1 �±tD id ede. iVea rt es
Business Namerlf'ype: A � 1�
previous Business on this site
Describe the proposed business including use, number of erraploye , na�rnb r of sFeiPts vmilable parking s aces, number of
icic and any additionsal�inPorrnation-that you can pr vi c: j J� C
'This Clearance will only be valid on the parcel for which it is approved. If you change, intcnsify or move the use to a new location, a now 7aning
Clearance will be mquircd-
1 bcreby certify that 1 own or havc the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accurate t g t best y Irnowicdgc. I have road the conditions of approve and I understand them an will abide by *cm,
Signature Printed`
APPROVAL TNf ORMA` ION
C )Approved as proposed Approved with conditions [ ] Denied
[ ] Backflow prevention device antd/ot' cu mnt teat damn need'ad'for this site. Contact ACSA., 977 -4511, x119.
[ ] No physical site inspection bas been done for this cicaTmice. Therefbro, it is -not a determinartion of compliance with the exisdmg
site plan.
[ T1t' site complies th th gimp,[ ats of than date. �j�•G� {��C1�1
Date a
zoluing, mcial — - - -�� )(Date
Ili- e
County of Alberrnarle Department of Cotnnnunity 1kvelopmont
401, McIntire Road Charlottemville, VA 22902 Voice: (434) z96 -5&,32 Pax: (434) 972 -4116
Revised 04/28/08 Page 2 of 3
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08/07/2008 12:13 4349514202
lrxtake to complete the following.-
Y/N
is use in LI, EII or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil 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 privatc. well ublic watea'?
If private well, provide Health Department onn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appIt
Is parcel on septic or c aewer?
/N
be putting up a new sign of any kind? If so, obtain proper
Sign permit
Permit #
4Se be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZODi a to COM13lete the followiny--
LAURELS OF CVILLE PAGE 06/06
Reviewer to complete the following:
Square footage ofU�;
rl)/ N
ermitted as:
Under Section: '�4• d -
Supplementary 1 cgularions section:
6k
Parking formula.- /-76
Required spaces: � of
Y/N aG
11 ms to be verif a in the field:
i
Inspector : Date:
I
MM -
Viol 'ans:
Y/
If s ist:
1Proi'f ;
Y/
If so, ist:
VBrr Ce:
Y/
T. f so; st:
sP's:
if s #ist:
dClearnnccs:
SDP's
Revised 04/28/08 Page 3 of 3