HomeMy WebLinkAboutCLE200800196 Legacy Document 2013-03-180 0-u Lkr4-N� 12�)-Qoly
Application for Zonin Clearance
CLE # 9- I
��RC'ANP
F] Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: 'Q
PLEASE REVIEW ALL 3 SHEETS
Receipt (,p Staff:
PARCEL INFORMATION
�� ' �� °r � Existing Zoning IS
Tax Map and Parcel: P J 6 I s' 7
Parcel Owner:
Parcel Address: woo E 12 ? o City 'le j /140- State O -- Zip
(include suite or floor)
PRIMARY CONTACT /
v /
Who should we call /write concerning this PT oject? //I u�
Address : �C�°1 � City / dt (nl c�4� State Zipa�
Office Phone: G71 Ge 1 # '' :' %'�: li' # E -mail (c4L ®r d
.
Wax
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
(/G oae Li
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, nu her of s fts, avail le parking spaces, Dumb,�f of
h� a II ``
vehicl s, and an add'tio al information that ou.ca prov de: / x— c /! 1Jh Gm19
✓ �
V 4�
G f V' t a
i Q C 7
*This C earance wi 1 on e valid on the parcel for which it is approved. If you change, intensify or move the use to a n w location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the o r s permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the bes m iowledge. I have read the conditions of approval, and I unders nd the alfd that will abide by them.
Signature Printed
APP ROV ORMATION
[ Appro as proposed [ ] Approved with conditions _ [ ] Denied
[ ] ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[vj 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 ,om�lie�s with tl sit pl4n as this date.
32 ��ifitsJlt�
Notes ✓{M .1.�
Building Official ' Date Cz < <L Cu
Zoning Official Date O
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
II
Intake to complete the following:
Y N
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y IN
Wi -Chere 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
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?
—
Y
W1 e putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
W e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: r0 6
/N _, �(i
mitted as: �l
Under Section: 1,5.
Supplementary regulation sktion:
Parking formula: qhm�un O&Z�
Required spaces: AA
YY /N J�LN
Items to be verified in the field:
Viola . ns:
Y/,
If s , List:
Pro a s:
Y
If so, List:
V i ce:
Y /
If o ist:
SP'
Y
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3