HomeMy WebLinkAboutCLE200800198 Legacy Document 2013-03-18Application for Zoning Clearance
CLE #DAR'
Zoning Clearance = $35
OFFICE USE ONLY
Check # 141 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # `7 4L Staff:
PARCEL INFORMATION
Map Parcel: 61
Tax and Existing Zonin
Parcel Owner: t*(&,�,•% i C COrk u� t`n Cc a C LC
Parcel Address:`_ City Ckc- 1(a -Ke,SU 1 State U0.. Zip 'ZZC10I
(include suite or floor)
PRIMARY CONTACT nIf
Who should we call /write concerning this project ?fGUn
Address: qC1 (.o Ro es Dr • City HmrisoyLbuf� State Va Zip
Office Phone:( 46) L438 -91�g1 Cell #SqQ - '013815 Fax #5((0 -'Q6' ?qq3 E -mail bra'ldc,^ r ce.ecM
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: i ibr t"i"ff PbA ems+ 1 Fz?,v,SP04 A-&6"("c e Co.,go -vi �
Previous Business on this site / 1GwtV C C01wPL1V-g L t.0
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: 021'ce _ -For
M _
*This C earance will only be valid on tae parcel for which i is approved. If you change, intensify it novIZr to a nek location, a new f Wj9g' . i1;.
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 knowled . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _--Printed &aAj0f0A (1)e6LV t(
OVAL INFORMATION
E Approved as proposed [ Approved with conditions [ ] Denied
tP
[ ] 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 ite co pI. s y�;it� the sit plan as of this date.
"� °�
Notes:
Building Official Date
Zoning Official Date / s/0 7
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
/� I?Z-
Intake to complete the following:
Y /�)
Is use in LI, HI or PD1P zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /D
Will 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
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Heal apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic o public sewer?
Y
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/
Will t ere 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: "[
/ D
rmitted as: �✓W`'J wl� - f/`l "
Under Section: / t • 0� '
Supplementary regulations. segtiorl:� 7
Parking formul : 7 I /Zd l) VL�
Okpia
Required spaces:
Y/N
Items to be verified in the field:
Inspector•
Notes:
Date:
Violations:
Y/N
If so, List:
fern:
Y/N
o, 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