HomeMy WebLinkAboutCLE200800163 Legacy Document 2013-01-28Application for Zoning Clearance
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USE ONLY �Zoning Clearance ='$35 Check #
PLEA E REVIE HEETS
PARCEL INFORMATION
Tax Map and Parcel: Ll ( -t'. '' Existing Zoning_
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Parcel Owner: 1' O i I1 ii i
Parcel Address: 15t p �rl�C�.0 ✓(1Sr�� �Gl <l City Chat I t ICSuq' k State Vet_. Zip 22-611 /
(include suite or floor)
PRIMARY CONTACT Y:1r,
Who should we call /write concerning this project? "'41
Address: ( ✓CSSInGi IC(t City CJ as 1 D#1S 07 6 State _
Office Phone: R3 9T6' y?fj1 Cell #1 Fax #G'r,5 -1 S Q 5 E -mail
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Zip ZZgiI
C, n(lSn
I APPLICANT INFORMATION I
Business Name /Type: Fexc - Lu l J-t Gu-)
Previous Business on this site n I ,,—
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: W t \n1Q() V 4D h)oS� (i X el 1 f - e S.i..m V6
U I?i�'; Lj) 1)`tt(J li r!i "J VyC?• �iili i>.F
pCif "i.\ I �i..l,. Q) r' )t) k: t.J)
`This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed \,-Q_n ✓
County of Albemarle Department of Community Development -
McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Application for Zoning Clearance
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CLE # 2, 93 — 03 ' n
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PARCEL INFORMATION
Tax Map and Parcel: � �-i
Existing Zoning
g g 1 ( T
f, '
� 1
Parcel Owner: � ! 1 i � � - , !, / V I`LA
' �t� ty l�Y IQ, -1 l31'ICS1A (L State V G - Zip �q t /
Parcel Address: I�ib P�rr�Q��..✓(�ssi'n� Ci
(include suite or floor)
PRIMARY CONTACT 1-Ir
Who should we call/write concerning this project? -.. I
Address: i (�!�(� CVCSSInGi R( City 0.04-'S 0 State V a- Zip 2-2-'71J
Office Phone: ��t � '� 1 Cell # - 5, b V Fax #JJJ AQ5 E- mailWAIZk i' P r"S11.Ct✓h-
I APPLICANT INFORMATION
Business Name /Type: _ Pe acp- Vtii- L ►"trcu —) (/hu -" tJin
Previous Business on this site n I 6�—
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
C.�
vehicles, , �R y a you n� -6 hoSk a 4 ell 4 ( S -1-)V � Fbr-
r I additional information that ou can provide: � k �nlQ
`�t!\ s and an addi
vehicle, 1 � l�� ��'� f` W9, kA)! §i G rr,
"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 flee best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
0
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
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
ill 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 or piN Clic wate ?
If private well, provide Health ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
i
Y/N
Will you be putting a new sign of any kind? If so, obtain proper
Sign permit. /
Permit #
Y/N
Will there be any ne construction or renovations?
If so, obtain the prey Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
Permitted as:
Under Section:
Supplementary regulat'ons section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
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