HomeMy WebLinkAboutCLE200800201 Legacy Document 2013-03-18Fax sent by : 4349726221 thomas je££erson
10/21/08 14:51
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Application f or Zoning Clearance
`1
cu, 201
-
OFFICE USE ONLY
[zoning Clearance = S35
Check # U-3 $ (� pate: [ fl 8
PLEASE REVIEW ALL 3 SHEE'R'S
Receipt # Staff-
PARCEL INFORMATION `}
O zopjng,
'fax Map and Parcel: i r Existing -- ;
Parcel Owner: VU'- o rz
' ,
�f1A �1� 1►, `�srf*t City DttL k e State . Vb ziP
Parcel Address:
(it,chrde suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this projecC!
6drL� — City State V Zip
Address: Hsu 1
Office Phone 1 Cell #Jam ' 1,57Z )rmx # iJ 1F—mall 1M v- 4el
APPLICANT INFORMATION
Check any that apply- Change of ownership Change of ase Change of name New business
Business Narne/I`ype: CYlh2 t W� �1 [vim d 'S
Previous /Business on this site t
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number pf
) hC- �' �i `^ '� -ti--e- [ 41iA1\1 f,
vehicles, and any additional information that you can provide: LA t ►n5 0 9e ;k A, ,
otn Uctla
'This Clearance will only be valid on tiro parcel for which it is approvtd_ Ifyou change, intensify ormove the use to a new location, anew2oning
Clearance will be required
1 hercby certify that I own or have the ownc's permission to use the spucc indicated on this application. I also ccnO that the information provided
is true and accurst to the hest of my knowledge. I have rwd the conditions of approval, and l understand them. and that 1 will abide by them,
Signature Gt t—r —' _ Printed L� S
�ROVAL INFORMATION
Approved as proposed ( Approved with conditions [ ] Denied
[ ] Hacktlow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x 119,
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
r ] This site c ,,� lid�ss with a sit e I of this date. I
N es: site G r =t tMRe,+ r��t��h� Glt�/t/�1�CAr�• . W1i(t
Building Official Date o �L?-
gtngOfficial gate ^_ -_-
/Y d
T Date f
tficiml
County of Albemarle Department or 4- vauu -1114y �.� - ....r.... ..
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
r"-z> �� e-17 r N.'zD Revised 04/28/08 Page 2 of
/Cb r ! ' 19 <7'2a 61 h .S op-- o+/ t fir . L i2
Fax sent by : 4349726221 thomas jefferson
Make to complete the following:
Y
Is use in LI, HI or PDIP zoning`? If so, give applicant a Certified
Engineer's Report (CER) packet.
VL9 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-the lies
is parcel on Rl�rN3-te we I or public water?
if private wePlr pr, d Health Department £orm-
Zoning review can not begin until we receive approval from Health
Dept FAX DATE
Circle the one th applies
Is parcel on kph or public seweO
P
Y
Will you be putting up a new sign of any kind? if so, obtain proper
Sign permit
Permit #
Y
Wi ere be any new construction or renovations?
if so, obtain the proper Permit
Permit #
18/21/88 14:51 Pg: 2/3
Reviewer to complete the following:
Square footage of Use: I r-5-66 S -
Y/N IIee^^
Permitted as:
Under Section: 16, 2 • [
Supplementary regulations section: r:3- I Z65
P rUPoS�c J i �1 {b✓••y 3 z. (d�,
Parking formula q
Required spaces: + >. I
13 Sp rcti t3 s�, Drtiv, ��
Y / N
Items to bAirrif
Jed in the field:
Inspector : Date
Notes:
Zoning to colon llete the followin
Violations. )Proffers:
Y / Y /Q
If s, ,
I f so , rat:
Variia�nce"
I s/ci List:
SP's
If s�ist:
SDP's
Clearances:
Revised 04/28/08 Page 3 of