HomeMy WebLinkAboutCLE200800204 Legacy Document 2013-03-18N/'_ Pnw
Application for Zoning Clearance
CLE # 2006_::_ q
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Zoning Clearance = $35
OFFICE USE ONLY 922 v
Check #✓ Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 Staff:
PARCEL INFORMATIO
h Existing Zoning
Tax Map and Parcel:
Parcel Owner: e�(,(14 /
712 /V 1qj// xe '
Parcel Address: 6gt3 I— /Z(-' City j/1Q,�1U11ei5j11 GState
(include suite or flo r)
PRIMARY CONTACT /
Who should we call /write concerning this project?
Address: 3 q () (S f_. 1_4 A_e_ City l State 1A Zip a%
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Office Phone: (� Cell # `i°3L /— 976 yd Va # E -mail +)nd elt. � (1&OWIaS-1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: ( 0 w n -1-,r !d
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:
*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, a new 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 ' _ Printed ,�,�rr �o �� (CriJLL•
APPROVAL INFORMATION
[Approved as proposed { ] Approved with conditions [ ] Denied
/[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -45111 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 Date
Zoning Official Date
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
A)e4
Intake to complete the following:
Y/G
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill 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 es
Is parcel on ate well r public water?
If private we rove e 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 / �N
Wil yy'ou'be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnlete the fnllnwina-
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, 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