HomeMy WebLinkAboutCLE200800195 Legacy Document 2013-03-18Application for Zoning Clearance
CLE #
OFFICE I Y y w
0
E] Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION {�
Tax Map and Parcel: V ��c�" � D % Existing Zoning p�
�
Parcel Owner:'`
a
Parcel Address: v City v State ZipG
(include suite or floor)
PRIMARY CONTACT � � � �� {���
�'/ CiC`�
Who should we call/write concerning this project. L� Z,
4640
Address: C • 0 1 'c7 s is-1 City e6yc r (o ,<- State ��� Zip
Office Phone:( ii) � 3 •°�7,.� 0% Cell # Fax # Zq,�4169 E- mail .,,idu'A �7 ( :4A— u- lea6 �c es
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: a— b 0
Previous Business on this site
parking )
Describe the proposed business including use, number of employees, number of shifts, available parking sP,aces, number of
vehicles, and any additional information that you can provide: f ��h ( clul .z IZc-e.;
*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 e best of my laiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
1.., , � ��
Si �atur Printed���°�
SY
APPROVAL INFORMATION
[,•'] 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 _ -Z 4.
Zoning Official 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
C't'm
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
V YYN
11 there be food preparation?
If so, give applicant a Health Department form.
Zoning review can n begin u we receive approval from Health
Dept. FAX DATE
Circle the one that es
Is parcel on rivate we r 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 tbLt applies
Is parcel o e r public sewer?
Y ' 0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
N
Will there be any new construction or renovations?
If so, obtM t e r er P t.
Permit
Zonin2 to com lete the followin :
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
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