HomeMy WebLinkAboutCLE200800161 Legacy Document 2013-01-28Parcel Owner:
FA
Parcel Address:'21 -`S cx,)VAS C'_ City �,rl�f �� �e I''� State 'n Zip 2J-
(incl de suite or floor)
PRIMARY CONTACT �' "�pi
Who should we call /write concerning this project?
c�E� l�
Address: I��� �� eICXc"'GiYI U'Asf City W Vu1GS�J��rc� State UA zipZz�64
Office Phone: C 2_� �7 Cell #,,510 yj I Sa %0'ax # E -mail he "4 e�It)5 , e-"
APPLICANT INFORMATION
Business Name /Type:r{=
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numbe ,'QQf
vehicles, and any additional information that you can provide: I-R.; L�x�� 5£�C�L�r►t r�kexxst�U S . �-� ''1s
*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 accu %ato the best of my , wl d e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature V Printed ���c_ �Ify P1 I(AC -010/ >
KU V AL LV k'UK1V1A 11I
pproved as proposed
] No physical site inspection has been done for this clearance. Theref6rc
site plan.
[ ] This site complies with the site plan as of this 'date.
Notes:
= 4511; x11.9.'
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
n� � � Revised 04/28/08 Page 2 of 3
Intake to complete the following:
Y /iii
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /9'fl
Wil sere 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 u is wat ?
If private well, provide Hea h De 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 er?
Y/N
Will you be putti g up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # `
Y/N
Will there be any new construction or renovations?
If so, obta' the proper Permit
Permit # 6 ?,00 S -13,33
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1yc�
YON I
P-efrmtted as: r— Lx
Under Section: oS6
Supplementary regulations section:
Parking form
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Prof r
Y/
If st:
Variance:
Y/N
If so, List:
SP'
Y/
If s , List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3