HomeMy WebLinkAboutCLE200800165 Legacy Document 2013-01-28Application for Zo ing Clearance��p4A
CLE # 2 D
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A. Zoning Clearance = $35
OFFICE USE ONLY
Date: `
Check # Z %�"� O
PLEASE REVIEW ALL 3 SHEETS - .
Receipt # -71-4 �7 . ' Staff-.1
PARCEL INFORMATION
Tax Map and Parcel: TA-4 MAP 5(oQ2 SECr70t4 / &ACEGS 12.,q?- AExisting Zoning JZ AkAt. / 1Z e1 4S
Parcel Owner: C P1,16Lu.S e-P -cwt' PARy- k r_V-kc-
Parcel Address: 10'15 Cr -k *v,,LX (_ t UV PAMCity CRoZCr State 1/A Zip ?aR3, -Z,
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
` ,
Address: 6342 14;IIS6110 (1o1 -m- City C V 0-1 f,+ State V A Zip ZZ9 37-
I
Office Phone: Cell# R53•'1g3D Fax# 823.2211 E -mail
APPLICANT INFORMATION
1. Check any that apply-.' Change of ownership - Change of use ;' Charige:'of name New business.
Business Name /Type: _e014C01. -r % P) (_w L I F-y -NDJZA LI GrA— VOR_ CRb"zI PAAL UN
Previous Business on this site Cro1,e-k Prr�s ouJ C6,- -�4 4 4-1 ti p -ew qt4 -C)
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: '56:6 Azuw-/w sk* -TcH IT I_4'L/ .
*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 knowlqLe. I have read the onditions of approval,, and I understand them, and that I will abide by them.
Signature Printed v 1CP'� ti'/ J j r' C ld
APPROVAL INFORMATION
"proved
[ ] Approved as proposed [ with conditions [ ] Dented
Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x
] p T19.
[ ] No physical site inspection has been done for this clearance. Therefore it is not a determination of compliance with flue existing
site plan. „ .
[ ] This site complies with the site plan o this date,./
Notes:--m a 'i✓rwt• "1 -ro-�c-
Building Official Date h "
Zoning Official Date. 8
Vt
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
Intake to complete the following:
Yi!/�N�
Is in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
W411 there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not egin until e r ce ve approval from Health
Dept. FAX DATE �
Circle the one that applies
Is parcel on private well or lie w ter?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applied,
Is parcel on septic or p blic s�wer?
Y/N
Will you be putting up 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 proper ermit.
Permit #
Zoning to complete the following:
Reviewer to complete t e following:
A Square footage of Use: �C(-
Y)/ N
Permitted as: N
Under Section:
Supplementary regulations section:
Parking forme" "
Required spaces
Y/N
Items to be verified in the field:
Inspector; Date: _
Notes:
Violations:
Y/
If s ' ist:
Pro Oe s:
Y/N
Ifs , ist:
Vare:
s
If s
If o, ist:
SP's:
Y
If Jcgist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3