HomeMy WebLinkAboutCLE200800194 Legacy Document 2013-03-18Application for Zo *ng Clearance
CLE #
❑ Zoning Clearance = $35
OFFICE US LY
Check # IWA Date: 1
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
P(7✓LiG
Tax Map and Parcel: 0.3 Z o.q ° Od- oo - oq i K 0 Existing Zoning ,l�+'� (�
Parcel Owner: i 10 5,60066 VI L No t t, / f°iiG l� o L,L C
Parcel Address: Zy V LorL)ood 19r City aw Jo44cYat 16 State IJA Zip 27- 1)
(include suite or floor)
PRIMARY CONTACT �--�
Who should we call /write concerning this project? a �11Lbv
``s AA
Address: Soo �e��fl�� I.R`_ City(�M &V(Offc5J IL State ZipZZ201
�, ,,�
Office Phone: (y3') � &'f Cell # , Z Fax # %73'" 3 21 E -mail ✓J(` ]c�s����. r�� G® r.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: o V i 6 455,5 -Ur et L ( %� �+PJ�Jr.✓��
Previous Business on this site P®atJ9_ &A- - LAV O
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: �'.OS � �l% vsf�( hew " a, tt Assc5}e_Q
CrF f� l U 4r-A cue 1l c1>� ila L'�%:: tMLf
Fes- 5 o Ere_ 7 CAk" eb an SWe— &MA 9 4d1k 1 uic,e_y'
*This Cregrance will only be valid on the parcel for which it is pproved. 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 est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed C�i a7�U/ l7 t /.�3 0ca3
APPROVAL INFORMATION
t7 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 A -+-� -� �o Date1
Zoning Official lyr- Date
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 04/28/08 Page 2 of 3
Intake to complete the following:
Y ' t.:!
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
V Y j/ N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can n be in til we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o u ►c 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 o ublic sewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
,1)/ N
Will there be any new construction or renovations?
If so, obt ' e e xk
Permit #
r IAgrbd j 9 r1710,e
Zoning to comDlete the followine:
Reviewer to complete the following:
Square footage of Use:
/N
Permitted as: ey ,Ik 1, -Y,M,
Under Section: '57
Supplementary regulations section:
Parking formula:
Required spaces:
lkq
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Ybist:
If s
-troffers:
/N
If so, List:
Varig ce:
Y /1�
If so, List:
ffs:
N
If so, List:
Clearances:
,4 4 "/
SDP's
Revised 04/28/08 Page 3 of 3