HomeMy WebLinkAboutCLE200800193 Legacy Document 2013-03-18Application for Zoning Clearance
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CLE #GC��
❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # 6/4`✓k Date: I Ail
PLEASE REVIEW ALL 3 SHEETS
Receipt # .R 3 , Staff. u i S
PARCEL INFORMATION
Tax Map and Parcel: -VL)� Mo-12 ?8, Fa..ve e-1 a08 Existing Zoning
Parcel Owner:Ll i l 1e- Land t_t G
Parcel Address: 11119 l R;r_krvto,,d r2d. City elm lo4{esyi Ile. State Vi r 'Y;e . Zip 22.q I I
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 4--:t4 I t_ C-o 'J E TT
Address: 2120 S; a.P NA;1 I rl dU . City 2 ,State Vir ln. y_ Zip ZBZ30
Office Phone: (OQ4) tp -4e -19000 Cell # Fo+3L1 '+- 8fa42Fax # E -mail pGoenat - 0 CM C t-t Q. eon.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name v-'-New business
Business Name/Type: I oP21Lg �S S4-'Qa..k ka ut �
Previous Business on this site N A
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: n nail.! ve.L uxani�, M -Th ?a- lop 1✓v - Sat 7a -t�
,., Ito.-lop 213 s`a4s 1 qI p4wwcq .L-P4 rsts 2 shi ;+.s wig
1 Z e• y l�oYreo per shif+
*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 h ie read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Efl'1 -!� G0"E-r -
APPROVAL INPORAkTION
[ ] Approved as proposed [ ] 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 site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official 0 in dip, Date ` .-
Other Official Date
County of Albemarle Department of Community vevetopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
LAR
Intake to complete the following:
Y / ft)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
P i /N
ll 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 a�
Circle the one that applies
Is parcel on private 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
Circle the one that applies
Is parcel on septic or public sewer?
/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 046— — tvl� (1
Permit# <-.q— ry, .,�.At✓,� ;try
0/ N Q
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # -' v V ` — d l / � /
ZoninLy to comiDlete the followin :
Reviewer to complete the following:
Square footage of Use:
/N
ermitted as: RAI' A'. e a,9
d
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector•
Notes:
Date:
Violations:
Y/A
If so, List:
Proffers:
M/N
f so, List:
Variance:
Y/6
If so, List:
SP's:
&/N
If so, List:
Clearances:
SDP's
U�
PDur
Revised 04/28/08 Page 3 of 3
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