HomeMy WebLinkAboutCLE201300028 Legacy Document 2013-02-19d
Application for Zoning.Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 6) 1 � L( Date:
Receipt # Staff: U
PARCEL INFORMATION i r W -w O� ��
Map 1 0•14 coo a
Tax and Parcel: VI Existing Zoning LM4 Pyles/
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Parcel Owner: L L C-
Parcel Address: 2E> 6 > � �CM0-,- Or- City C6,- fo b eW 11 CState V r4 r Zip
(include suite or floor)
PRIMARY CONTACT `
Who /write v e++c
should we call concerning this project? Uq
Address: 2120 QerlC -MC-i O.r, 0011t iD City lino- ✓)oHes- 1t State VC, • Zip
Office Phone: �� ael�l - bo 1 f Cell # 5`7 )-23-7--74-5 Fax # 00(o 2 E -mail _ c(Uc, U e'74>m
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: C T I CzhSV l-1-. -w-ts Jet c
Q/��� 1 l- i ,,,,�r
Previous Business on this site �JrCAI `! e 7: "La
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
1-[
vehicles, and any additional information that you can provide: 4 W, 0 1vq 1'51,5 ►,�. p ctc•c_ �.
2 v C `ni�OS w 1 tQ i f CJYi, 'U', A
*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 �Jp � pv y-g44v-
APPROVACINFORMATION
- ['Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 _ �I t
Zoning Official G'L ./ Date y /)/
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 7/1/2011 Page 2 of 3
Intakee to complete the following:
Y I�QIs u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 =blicate
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 ap 1es
Is parcel on septic or public sewer.
Y, N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: Z 2 Uy
Y.)/ N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
G ya ,,tea/ •
Required spaces:
Y�-
Iten 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 7/1/2011 Page 3 of 3
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CONSULTANTS INO
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Ligure• At k (0B, 5" 1
Date: 4
Prepared By: Joe.
Scale: As Shown ❑ Not to