HomeMy WebLinkAboutCLE201300041 Legacy Document 2013-03-11I &t 4A
Application for Zoning Clearance
CLE # W 13 V A-1
Is-
FFICE
O U ONL
o 2 .217` 13
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # I Staff. 1-YU74,
PARCEL INFORMATION ..// //��
Tax Map and Parcel: OG I VO -03- 00 -00700 Existing Zoning C-' 1_ l,0M►rhare.wi
Parcel Owner: L L C. / -T6 Wt L S L 4 1?N 6 ip,
Parcel Address: lrre coo 6r:er -br• She >7 City Chg ,o /akest2u,61'State Vdf Zip J,ftx
(include suite or floor) 3
PRIMARY CONTACT j �
�-�
Who should we call/write concerning this project? ' o}u i}W J��NGt= Or —! 04� e etJ
'�
Address : 57S y0 � "1M y y �i S City /� i iha State Zip w
Office Phone: ( ) Cell # E -mail lea u • L 4 W re N C e!
N�}'1'zcn��l.coV,�src. =NG -soup. x,1,,,1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: k- ryotjAL 60UPS61,aNCr C,_rzcU1P, :E—,v C_
Previous Business on this site el 1 VVA S+ON e— & I/h21A c tj C- .
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: H r_a l - 4% en u N s a l iuc
se,rv►ceS . 1 -[-o C ew.lole��ees %Au�f�ow►t�bf /cs. VA�yir14 sl►i �•�S•
*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 certi have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true ar cra to to th est wledge. ve read the conditions of approval, and them, and that I will abide by them.
�Iunderstand
Signature Printed lAv/ �/�!�/ F/✓cF Z=Z 2.� Zola
it/c(Y V P
APP .ROVAL INFORMATION
[ pproved, as proposed [ ] Approved with conditions [ ] Denied
[ ] 13a5 WW prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ o 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 O I
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
Intake to complete the following:
Reviewer to complete the following:
Y / N
footage of Use: 9
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will there be food preparation?
ESe
f , Lb
-�
tted as: o f
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o ublic water?
If private well, provide Health ep ent for
Zoning review can not begin until we receive approval from Health
Parking formula: L
Required spaces:
Dept. FAX DATE
1
Clearances:
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic public sewer?
Y /(N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y (DN
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/N
If so, List:
Pro r .
Y
Ifs ist:
Variance:
Y/N �
If so, List:
SP'st•!�
Y /I1v
If ski/ st:
Clearances:
SDP's �n+
J
�l2
Revised 7/1/2011 Page 3 of 3
w �In�►�
OHIO
K 'd 6816 W b£b 'ON XVA AOOIOONO /NOIIVIGVN dM WV Z£ :80 Q8M EIH -H -83J
zQ
J
IL
Ir
0
O
J
LL
6
'm
l\
n
•
! j �
.� �, psi
ia
s`
• �
� s'
W
r
tE
X.
CL
v
i;
I
r
I l
3
o
.__. r _ _.�_
sir-• �. �..� _ a� i.
.-- `.
Ul
//�
lit
00
r
�
•D
70
0
-0.
CD
rD
j