HomeMy WebLinkAboutCLE200800208 Legacy Document 2013-03-18Application for Z rin learance
CLE # jbU Z
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Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE NL
Check # i Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: / / �/ # Existing ZoninLy
Parcel Owner: Lam" ' � L �C r� - d /KS , , ✓IJX&l -5 A
Parcel Address: / l /� c� /G �iJ /G `" City G ��/ `� State /✓ Zip
(include suite or floor)
PRIMARY CONTACT -�'°
Who should we call /write concerning this project? � /A 19�-{Z_
Address : T-r (e ST A/Arek. T S• City N Ar(GISo State �/¢ . Zip y/�
S`2 S 14A &,4-416T S'r2eeT 3;vN� F7• 2
Office Phone: (� Cell #��" %d :2�ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use - Change of name New business
Business Name /Type: t,
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.
Signatu Printed &J,6- AA5-
APPfiO AL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or currenttest data needed for this site. Contact ACSA, 977- 4511, x119.
[ ] No physical site inspection has been done for this clearance: Therefore, it is not determination of compliance with the existing
site plan.
[,P'T his site complies with the site plan as of this date.
Notes:
Building Official Date 9 1 :!L-
Zoning Official Date �i D
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
V
Intake to complete the following:
Y /
Is u aI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Willi / ill 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 or
If private well, provide Hea
Zoning review can not be
Dept. FAX DATE
Y/N
ie Items to be verified in the field:
s er?
a new sign of any kind? If so, obtain proper
Inspector : Date:
/ N Notes:
ill there be any new construction or renovations?
If so, obtain the proper ermit.
Permit # Z1DD8
Circle the one that ap
Is parcel on septic or
Y/N
Will you be
Sign permit.
Permit #
form.
Reviewer to complete the following:
Square footage of Use:
fitted as:�v
.SOD 0
Under Section: (X ' a'
Supplementary regulations section:
A` q
Parking formula:
s-,t � a /cvt,
until we receive approval from Health Required spaces: `, �
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:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3