HomeMy WebLinkAboutCLE200800199 Legacy Document 2013-03-18Application for Zoning Clearance°
CLE # 200 6 — F� 9
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Zoning Clearance = $35
OFFICE USE
Check # 19L Date:
PLEA ALL 3 SHEETS
Receipt # O Staff:
PARCEL INFORMATION
Tax Map and Parcel: 1'►'j #0 S -, c 1 Existing Zoning L
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Parcel Owner: V9 ► is 1--40, � kk 1 d t YI e
Y n
Parcel Address:1365 L n YJQ W1 City. State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
, /
thItr State Zip
Address : 3Y6 &yeCd1 byn r Or S ,)tt,t 2 city Ckerld1fr ,) V#_
Office Phone: 1,3 y7 "2 o 6 Cell # Fax # 02 3 f• E -mail yj ee %.1eoLde, 4 SeVA.0VAI-
qi/'.00;;
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: S o o rk ey yi 4)1/, _T N1 C 1V e_ CM o o 1 C G 1 c O✓1 yyac-tcy
Previous Business on this site
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: m C c,�C n . C e. C6y1T 1'A L r0✓ ' t5 f � i e e-
�r 56 ' e- a O D
h t
*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, anew 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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / l�/9 �J Printed /U'eCt I Fo uj ti°c—
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 <zz:N. Date
Zoning Official Date T /0ZOX
Other Official Date
County of Albemarle Department or L;ommumty lievetopmeni
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
i
Intake to complete the following:
W1
Is use in ()HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /N)
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 a lies
Is parcel on rivate well r pubilic water?
If private we , provi e ealth Department form.
Zoning review can not begin until, we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septi or public sewer?
Y/N
ill 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, obtain the proper Permit.
Permit #
7 . .. +., ,Y, r,1 +a +111a fhUnwina•
Reviewer to complete the following:
Square footage of Use: X 1 OF,
VY /
N
Pe /
mitted as: ��YL v M, YS �✓ Y✓1� �'i Y'
Under Section:
-2-?, 2,
Supplementary regulations section:
Parking formula:
Required spaces:
Y/ U
Items to be verified in the field:
Inspector : Date:
Notes:
uUlx r2 V
ViolaNns:
Y / /NJ
If so, rst:
Proff rs:
Y /Y
If so, rst:
Varian e:
Y
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
o6-3,9
Revised 04/28/08 Page 3 of 3