HomeMy WebLinkAboutCLE200800207 Legacy Document 2013-03-18Application for ZoninLy Clearance
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CLE # �D �
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�Zoning Clearance = $35
OFFICE USE Y G
Check # 9� Date: %
ASE
PLEA EVIEW ALL 3 SHEETS
Receipt # 2, fl-1 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 062to ()p -o) 5(Np (, &k Jays, � ��� Existing Zoning Xu,ra &fa
Parcel Owner: y) „ 1 LaI {/
/(
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Parcel Address: 37 , Lj. I"J Li ��� City -(Lr IAIJ yeJIQ State V�r Zip
(inclulle suite or floor)
PRIMARY CONTACT
Who should w1 ee call /writel, concerning this project? LLCi,S h,,, lrr
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Address: 11�� ri1E� , �() �c�, , �` City �'t�or1t AJ State VA Zip
Office Phone: ( O Cell # y3 9 6t -W Fax # 90 Gl HE -mail Cs's zci e y ��, , (6m
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �P� 1r c (es L
Previous Business on this situ(),,(I
Describe the proposed business including use, number of employe ,gs, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
o'
*This Clearance ill only be valid on the parcel for which it is gppfoved. 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 Uhl Printed
APPROVAL INFORMATION
[ ] Approved as proposed i 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 Date ci
Zoning Official Date Gv
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
L I �e�Revised 04/28/08 Page 2 of 3
Intaakke to complete the following:
Y(
Is HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y ll )
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 t p lies
Is parcel on ' ate hell or public water?
If private w r ide 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 s Yc or public sewer?
Y /IN/
Will( be utting up a new sign of any kind?
Sign permit.
Permit # 1
Y/N
Will there be an
If so, obtain the
Permit #
Reviewer to complete the following:
Square footage of Use: ()
P ermitted as:
Under Section: • 07.
Supplementary regu ations section:
A lIf
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Notes:
new construction or renovations?
roper Permit.
Zoning to complete the following:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3