HomeMy WebLinkAboutCLE200800190 Legacy Document 2013-03-18Application for Zonin^ Clearance
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Zoning Clearance $35 �1 ,
Checks# � 4k� � � r,, Date r ts� � r ''.
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PLEASE REVIEWALL 3�SHEETS i t
Receipt# � Z S Staff
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PARCEL INFORMATION
Tax Map and Parcel: - 110 r Existing Zoning U m Vrn ?.Y e l AL
Parcel Owner: k ii s,g n c . )AC,
Parcel Address: �) I ill u u d L, r a c k i City ChA Y U-� e S y J e State V A Zip 22 9 D
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? )3.t;+{1_A_ri u aA QYL Z f -ro
Address : 2 0,19 W 0 0 el h r0 J? k c 0 �r City WAD D loll a State VA Zip 2�
Office Phone: (j�_b 220 -1066 Cell# Fax #?t3{-2Z(1 , 3�Q�E- mailj „ }tJri�Jlloti�t2tottiira��ina1a
APPLICANT INFORMATION
Check any that;apply '„ Change `of ownership,,' Change mine, New
.. ., , , .Chan e`:`of use , of business!
g
BusinessName/Type: lyJtAyall Home, 06ntrachno ! 1_C
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. if you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify at I own r h ve the wner's ermission to use the space indicated on this application. I also certify that the information provided
is true and ac at to th bes of y kno le . I have read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature Printed
A 0P� O17 AL "ATIO
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rt LY } {,b i.l. vii �i, �'?i .7 7�f� x I$r1
[ ]Approved as [Approved conditions, Demed
proposed - with
[. ] ackflow prev'entton'devtce and/br,current test'data rieeded for.tlits site 'Contact ACSA, 977 4511, x119
`;,Therefore,
.[o physical life mspectton has been -done for thts,clearance tt is not a determination of compliance with the existing
site plan.
[ ] Thts site c nihe w tli the rt” plan as;of thts�datey
AP
Notes ° '
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Building Official
ZaingOfficial ' �' ''m Date
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3 a i� t 1 'I srr i, r i r ,
Other Official �` ,t �xtDate
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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
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Intake to complete the following:
Y /
Is u's�-ih LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
Square footage of User V `'
N
Y / d�
Will`tlfere be food preparation?
Pe$nritted as: G✓
Under Section:pc d' .
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regula ions section:
Dept. FAX DATE
ell 011-
Circle the one that applies
Is parcel on private well or lic wa r?
Parking form la:
Ir1� 6
If private well, provide Health a artment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
`
Y/N
Circle the one that appl'€s``�
Items to be verified in the field:
Is parcel on septic or ublic 4wer?
Y/N
Will you be p tting up a new sign of any kind? If so, obtain proper
Sign permi
Permit #
Inspector : Date:
Y / N
Notes:
Will there b7any w construction or renovations?
If so, obtain the proper Permit.
Permit # /
Zoning to complete the following:
Yio� ions:
,(( I If so, List:
Q r�fifvers:
So. A,
Varia cie:
Y/
If so List:
SP`s:
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3