HomeMy WebLinkAboutCLE200800192 Legacy Document 2013-03-18Application for Zoning Clearance
� �RGIN�P
OFFICE USE ONLY �y
oning Clearance = $35
Check # 4,905 Date: 0
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7,1406 Staff:
PARCEL INFORMATION
Tax Map and Parcel /27 9000noo DZ) Existing Zoning
Parcel Owner: . A 42�t=
Parcel Address: 1 Y-) C ✓V �-1 Ce fio ��� City (' h V' i, // P— State '1f o Zip -
(include suite or floor)
PRIMARY CONTACT v �� C
cc e "�- Suy &s
Who should we call /write concerning this project? (.Q� i j
Address: //10/LICtS �/eySm1 {�'C(City ��� �1`'E�. State VV ' Zip�/OZ
Office Phone: ef - 706) Cell #'Y3(19!;5- Fax # 1/,370?% E- mail _�ae�
$lit 339
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business QUIT lop
on this site 011i
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: LL'CZ �� %r� S�litace.L �Ar/��DVS c�DYVX I�
7
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
s
I hereby certify that I owi r have the ow r p nission to use the space indicated on this application. I also certify that the information provided
is true and accu to e best o my ki led K I have read the conditions of approval, a , I understand them, and that I will abide by them.
Signatur GAL Printed
APPROVAL INFORMATION
[7$—Approved as proposed [ 1A Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This pite complies with the site 111an as of this date.
~S, -a"LPe
Notes: 1' 444, r
41AL2A;
Building Official Date +F
Zoning Official Date Y
,�l��
Other Official �wr ramd, l 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
Intake to complete the following:
Reviewer to complete the following:
Y N
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Permitted as:
Y/N
ill there be food preparation9 C-"5+ i � �,��
If so, give applicant a Health Department form. /4 - Q,
Under Section:
Zoning review can not begin until we receive a proval from Health
Dept. FAX DATE � _C) R/ 7 �� I )�
/
Supplementary regulations section:
Circle the one that applies
Parking formula:
Is parcel onivate well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE C? —c! °-0 9'
Required spaces:
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. s ,
Permit # Aj
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit. /\j
Permit #
Zoning to comDlete the followinLY:
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