HomeMy WebLinkAboutCLE200800181 Legacy Document 2013-02-19X
NO
4.
.n nip'
Application for Zonis Clearance
��►�► ����'far
CLE #
.Zoning Clearance = $35
OFFICE USE ONLY Q
Check # 0 oy Date: ` 2( 0 "
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 '7 Z j: Staff:
PARCEL INFORMATION -
Tax Map and Pia l4 (1 P i C� Existing Zoning -� ),�jh� O P_ (T- i 1A
/rcel:'
�jj
'- LmU eb,
Parcel Owner: �(i rA i m
Parcel Address: 'Iqq -X),4e_ [ City(2y*-Ic{-�tc, U-4E State VA Ziplc 111
(include suite or floor)
PRIMARY CONTACT /) �LL
Who should we call /write concerning this project? Cwb � o e_ sum 5
Address: IM ��Q R-cl Wi`fb!5_ City e WOA��111L State -Zip ;1 G L
Office Phone: Fax # E- mailChflSiir�Cv�nSSpP?cha,cl,.
APPLICANT INFORMATION
Check any that apply:' Change of ownership" Change use':, Change of name New business
toff
Business Name /Type: ^ f— ►(gym -IJ J _P_cj, nd `be, ,onc u-G
Previous Business on this site 14��lt9tf�
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
ve cles, and any additional information that you p�de: p ,e
d -C2 �, a 01 ,
*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 laiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature •� Printed_ Ara, C
APPROVAL INFORMATION
XApproved as proposed [' ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -45I .l, x1 I9.
[ ] 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:
Building Official Date
'.Zoning Official .Date �
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
'C_o�-i
Intake to complete the following:
Y/
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will Ore 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 blic w 1•?
If private well, provide 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 septic or u is sew r?
Y /.
Wifl_y u be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /-(
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use:
/N 1�
emitted as:
Under Section: 2-�. 2-,
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/M
If so, ist:
Proff
Y/ E7
If so, List:
Variance:
Y/0
If so, List:
SP's-
Y/Q
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3