HomeMy WebLinkAboutCLE200800213 Legacy Document 2013-03-18- Application for Zoning Clearance
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CLE # Z009- 7,j 5
Clearance = $35
OFFICE USE ONLY
Check # _ 00 Date: r �'
-7 7-La Staff:
PLEAZoning
REVIEW ALL 3 SHEETS
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: D101140— Un - t Z 0D f A Z Existing Zoning C t (Qyk(me,,KC (` !j
Parcel Owner: K0 1 L-L-C.
Parcel Address: I bN fir, (r HA-1 - W- City r �{' (Z1 / �1LC�tate 1� / t' Zip VA L-3
(include suite or floor)
PRIMARY CONTACT
Who should we we/call/write concerning this project? ) �✓� I�f CIJ� 1�
C C WA411.b�1��SUlI� � N(A Zip V/ 6
Address :WA �N� City State _
Office Phone: % Cell # y�'��� I'd1r1 Fax # y� �/ el %) 'a�E- -mail �Ulntll GV
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of New business
name
Business Name /Type: ��� V I L LE L� (1C I ii (L 1�`� K 7 Ci- 5
Previous Business on this site �1 LLFi1�� A�T1�-
Describe the proposed business including use, number of employees, number of shifts, f vailable parking spaces, number of
f �
vehi''cle§s., antd any additional information that can provide: lr .t )��I C YLiGF— SiP j OeE N 0--12
�yof�u
*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 wledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature o c s_ Printed
A"kOVAt INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ jNo 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 i -Z> 1 l
Zoning Official Date O 1�h be
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
F/
(opK
Intake to complete the following:
Y /
Is u I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
re
Will 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 public water?
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 or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followine:
Reviewer to complete the following:
footage of Use: ,Jf06�
Y)/ N �
ermitted as: ° �M"i a( �
Under Section: Z J
Supplementary regulation section:
li�L! 0� -
Parking formul : L
iZ,o��
Required spaces: j
Y/N
Items to be verified in the field:
V�_ItL
Inspector : Date:
Notes:
Viola ' ns:
Y/
Ifs st:
Proff s:
Y/Y
If so
Var � ce:
Y N
If Sol, ist:
S '
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3