HomeMy WebLinkAboutCLE200800185 Legacy Document 2013-02-19Application for Zonin Clearance_®
CLE # 2190 a 4-- l �
vIRGINIP
Zoning Clearance = $35
OFFICE USE ONLY
Check # ' ( - Date: g/ Z �% 0 g
PLEASE REVIEW ALL 3 SHEETS
Receipt# 5!;' Staff:
PARCEL INFORMATION
Tax Map and Parcel: :1Z _-7 G
P Existing Zoning PO � C!
Parcel Owner: `t' �V y��► �L�
Parcel Address: /M„-) 60 City 7
('N./.1n, —T5yi"- :7State VA-) Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 402.r— S fA i X DLAAl Ka -
Address: ,. � y,
Address : �a,y y , ✓,� rl° City ��, ;-� v State _ Zip Z
ffic Phone: ct�,) ell b2- 95!2'7 Fax # 97s1 9iY1 "7 E -mail ac-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name New business
^_Change
Business Name/Type: (l, 4. t, , d ,LI 5 F-U"'— be SZ E"-6+2 ��-� n� f! 1 i rya
6;c
Previous Business on this site /U f A (iJ r^ vJ n „s T s-n J.-
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: CJor')
!Ut u , z a -r � (1) -f T,C, v J r s !a 1, �r
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
[ L,,TApproved as proposed [ . ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
sit�e an.
[ V1 This site complies with the site plan as of this date. !
Notes: /lit -.V- loo k /j 5*s- A
Building Official Date
r
Zoning Official Date zo// �f UPI
Other Official Date
%.ounry or tiuemarie 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 use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Were 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 puib�l w ter?
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 app lue '
Is parcel on septic or pu; is s er?
Y/N
Will you be pu jing 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, obtain the'. roper Permi .
Permit # �f
1
Sonine to'comdlete the
Viol ions:
Y /
If so, st:
Vari c / �e:
Y T�
If so, ist:
Clearances:
Reviewer to complete the following:
Square footage of Use: :3) / 6 (
iitted as:i
Under Section: '4210".
Supplementary regu tions section:
Parking formula•
Required spaces:
6
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
'EGG;;
Proffers: 1 f
If so,�st: G'
SP's-
t: III
SDP's
74510
Revised 04/28/08 Page 3 of 3