HomeMy WebLinkAboutCLE200800188 Legacy Document 2013-02-19Application for Zo ping Clearance
s CLE # `Z� /91 i
Zoning Cleat ance $35
PARCEL INFORMATION �7 �j
Tax Map and Parcel:/) —C� o, )-6 _14n, Existing Zoning 36
Parcel Owner: (der ItLJL 1 ur<;5�-
Parcel Address:—,(, %lam_ ��� . y e" iG State t J A Zip° -
(include suite or floor)
PRIMARY CONTACT
Who should we call /write Jconcerning this project?
Address : �i �7 /i 91ACIrP_ City State Zipd S
Office Phone: U Cell # G� /US S ?,S(;Nax # E -mail
l® u3 B"' - '
APPLICANT INFORMATION
Business Name /Type: ,N(? W �� I )IQ
Previous Business on this site
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:
*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 /1 1 %Il �/ lX � /f� _ Printed III Nei V ,
[; ] Backflow prevention device and /or current test data needed for this site: Contact ACSA, 977 - 4511;
[ ] No physical site inspection has been done for this clearance. Therefore, it is not.a deterninatiot of c
site plan.
[; ] This site complies with the site plan as of this date.
,Notes.
Building Official c
Date �t
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
14
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Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
,Engineer's Report (CER) packet.
/JN
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begi until we receij'e approval from Health
Dept. FAX DATE —sew -% OL - R.b��OI
Circle the one that applies
Is parcel on private well oi{ public ate
If private well, provide Heaj 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 ublic sewer?
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 new construction or renovations?
If so, obtain the proper Permit.
Permit # z a g - -\ % 5 .A-(-
Zoning to complete the following:
Reviewer to complete the folio , ing:
Square footage of Use:
T
ermitted as: .1,� �
Under Section: �0 3
Supplementary regulatioyys t }on:
6 Gt
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
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