HomeMy WebLinkAboutCLE201300046 Legacy Document 2013-03-11Application for Zo ing Clearance
0
CLE _
OFFICE UtT LY 11 13
1(( Date: h�
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # Staff: nn
PARCEL INFORMATION t j�
u Existing Zoning 4'
Tax Map and Parcel:
Parcel Owner: P�
Parcel Address: 'J b y 1: 4.1 City .C- V 1 l State Jam_ Zip ZzC101
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : 3 O L f�-c (5Cvta -t- City V l LL2 State yL, Zip
A
Office Phone: (]�� 3 LiD `? 3�1 #1 Fax # E -mail �'e-�� C�`e `lsLl-�Ik� l
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name V New business
Business Name /Type: ZL2- � �� LL C—
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: 4-" - (MA.Q- C- v
C-o q-r-
-A uc-i fo 5 0 4 CIt '1
*This Clearan e wil only be valid on t 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 PrintedlG�
ti
APP VAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[L"Ko 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 c Date
44
Zoning Official Date c7 ll 1
Other Official Date
County of Albemarle liepartment of Uommunn.y ueve1uN111c,1L
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised.7/1/2011 Page 2 of 3
s • C
Intake to complete the following:
Y -
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
En ' er's Report (CER) packet.
Y/
Wil -ere 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�lic water?
If private well, provide Heal e a orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or blic sewer?
Y/N
Will you be pAtting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 061V
Y/N
Will there be any new co c ion or renovations?
If so, obtain the pr ennit.
Permit #
7nni»/r +n orhmniPiP fhp fnllnwlnff_
Reviewer to complete the following:
Square footage of Use:
Y rmitted as:
Under Section: �q • U+ - I ` X
Supplementary regulations section:
Parking formula: '126b i V1 f�—
Viay ns: _ - _ -_ _ _ -- - -_ _
XT
Y �
Ifs ist:
Prof rs.
Y/N
Ifs , st:
Vari ce:
Y/_
If ist:
SP'
Y/N
Ifs ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
c�
-'T7
Floor Plan of Subject Unit
Pape and Company, Incorporated Page 40