HomeMy WebLinkAboutCLE200800197 Legacy Document 2013-03-18Lk_)CJ\1 l t'0
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Application for Zoning Clearance
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CLE # 7-0 V t . � 5 �
[Zoning Clearance = $35
OFFICE U ONLY
Check # Date: CO — J o -0
PLEASE REVIEW ALL 3 SHEETS
Receipt # '-7 r� % Staff-
PARCEL INFORMATION
(CT)[x /06 — 0 - -60-" /-7 6) Existing Zoning j`
Tax Map and Parcel: O
Parcel Owner: f J''-�l (i
11�� e y pLz9b
Parcel Address: . City (�' � V' 1 / �� State CA— Zi
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project? /mil d/�i' 60114Uj
Address : an ' C��� T City I �i State � Zip
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Office Phone: `V UU 1 C+7 ell # rd 1 v` ,A # E -mail - hol a ,fk)&ca
APPLICANT INFORMATION
Check any that apply: Change of ownership < Change of use Change of name New business
Business Name /Type: �� �V"'
Previous Business on this site
Describe the proposed business including use, number of employee , number of sh'fts, vailpble parking spaces, numb r of
'de: k 6t/
vehicles, nd ny additional i formation that you an pro F
f C le t c V
*This learancd wil my be AIR on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission t he space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowled h ad re the conditions of approval, andI understand them aiyd that ill abide by them.
7,
Printed G/` (tea
Signature �%
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APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] 3ackflow 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 qoi� it�the sits o�date,
Notes: kt
Building Official Date- 'tde l I.(v �
Zoning Official Date ��dw $
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/
Is u m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/N
Wil ere be food preparation?
If sjjive applicant a Health Department form.
Zom g review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or blic ater?
If private well, provide He Ith epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap ie
Is parcel on septic or lic se er?
Y/N
Will you be pp g up a new sign of any kind? If so, obtain proper
Sign permit. /
Permit #
Y/N
Will there be an ew construction or renovations?
If so, obtain the pr per Permit.
Permit #
Zoning to com lete the followin :
Reviewer to complete the following:
Square footage of Use:
P/ N Y l�fwtJ(
Permitted as: 11
Under Section: cz • -'
Supplementary regulat
t�ns section:
Parking formula:
Required spaces: f •�'A/) s� C>
Y/N
Items to be verified in the field:
Vio ons:
Y
If o, List:
Proffer
Z'
If . , 1st:
Var' e:
Y
I so, List:
SP's:
Y/
If � t:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3