HomeMy WebLinkAboutCLE200800206 Legacy Document 2013-03-18Application for Zoni Zz Clearance
0
m
CLE # %008
Zoning Clearance = $35
PLEAX REVIEW ALL 3 SHEETS
OFFICE USE ONLY 11-71
Check # ��S Date:
Receipt # Staff:
_
PARCEL INFORMATION �► `
Tax Map and Parcel: !1i;0�r �)!�� D9 �li��c1� -�i'o �Ji;� Existing Zoning (Feral Am
'ter
-J, Lz
Parcel Owner: hyJ 0 �
Parcel Address: 318 44 _nl)w (zJ City arlhkNvJ12 State VA Zip22��)
(includes ite or floor)
PRIMARY CONTACT , l
Who should we callA,vrite concerning this project? f ler I C)
Address � _) f li,W ],�;A 100 City Ual lti, ovule State VA Zip V
Office Phone: (Cell# t Fax # -mail C(S��l �,Cj•��a'
APPLICANT
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: „d I b? nm If WL
A
Previous Business on this sitee
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: LsioriS _ CS ( ;•
r e t`Q . .¢ rJ r
Irl a t � ?e.. I , ` 0-J , m e-
*This Clearance will only b valid on the parcel for which it is approved. If you change, intensify or move the use to a ne location, dnew 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 f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
I
�
Signature ' Printed C , �, P iS �,•r F%S �P
APPROVAL INFORMATION
[ ] Approved as proposed Q pproved 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 det >o of compliance with the existing
site plan.
[ ] This it plies wit he site pla as of t is d te.
Notes:
Building Official kJQ Date 1 t
Zoning Official Date d 0
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
Intake to complete the following:
Y
Is us I, HI or PDII' zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /n'
Wil re 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 a plies
Is parcel on ivat ell or public water?
If private we vide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one th applies
Is parcel on ti or public sewer?
Y /
Will $u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y )/ N
11 there 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:
Y / Permitted as:
Under Section:
Supplementary regulatio section:
Vl A
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
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
i
Revised 04/28/08 Page 3 of 3