HomeMy WebLinkAboutCLE200800205 Legacy Document 2013-03-18Application for Zoning Clearance
CLE #
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` OFFICE U NLY s ":
Zoning Clearance `$3S , I ;_, Check
PLEASE'It VIEW ALL "3'SHEETS Recetptt #' �I� Staff:
PARCEL INFORMATION
Tax Map and Parcel: Qg5e Q 03- Oy " 00 U-90 Existing Zoning
Parcel Owner: add IJeedk,,
Parcel Address: V O &Iva w Elva city6 Q rl- -Ms V" State V e" Zip zq b
(include suite or floor)
PRIMARY CONTACT n 2
Who should we call /write concerning this project? '15d F r-ed �c, �'�� ✓��- sv�0�z
Address: � �� ^T� e�58 `-� City �cx vw rc- State 11 c` Zip C t-
Office Phone: Cell # / ?/-Qif Fax # E -mail
APPLICANT INFORMATION _ I
I Business
I Previous Business on this
Describe the proposed business including use, number of employees, njumbe rf hif , vailable parking spaces, number of
vehi 1ps, and an additional info mation that you can provide:
Y" " " ><
*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 hav owne permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the bes f -.�Imo edge. I have re the conditions of approval,, and I understand them, and that I will abide by them.
Signature Printed
site plan _.�
"te date
,
Tlns c m Ices wrt the s ep lan a
oft s
Notes
.
%Buildiftg Official
Zoning Official
Date
3 D �S�
OthertiOfficlal
:
Date
County of Albemarle Department of community lrevetopment
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:
YN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(N )
Will ere 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 lzli��.�te
If private well, provide 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 ovwis sewe
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permi .
�
Permit #,- _ l Irt Sl�n
Y /
WilQtere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZOninff to com lete the followin :
Reviewer to complete the following:
Square footage of Use: L(/
Y N
Permitted as:
Under Section: j4 e2
Supplementary reguNions section:
-1
Parking formula: ( % l Z
Required spaces: I
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola 'ons:
Y/
If so ist:
Prof
Y N
s , V.
Iyara :
:
SP's:
If ist:
Clearances:
SDP's
Revised 04 /28/08 Page 3 of 3