HomeMy WebLinkAboutCLE200800217 Legacy Document 2013-03-18Application for Zoning Clearance
CLE # % c)o 3—,3 I
UJI OFFICE USE ONL`Y�
toning Clearance = $35 Check # Date:
PLEASE REVIEW ALL 3 SHEETS Receipt # --� "�� Staff:
PARCEL INFORMATION k'
Tax Map and Parcel: -7 g -3 Existing Zoning
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Parcel Owner: P at ;1d.Jr `e o m I`
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Parcel Address:_ _ %'� �L�� `� 2— 0 2, City C 4. e f /1'5 W11 State _ /� Zip
(include suite or floor)
PRIMARY CONTACT n
Who should we call/write concerning this project ?i��/
Address : IWO c YK IAIEM 44 V10, CityC/l/�,eZs -VIZ4 State Zi :22
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Office Phone: -741/4 Cell # Fax #
APPLICANT INFORMATInN
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �Y 7-4 %,if /'�Allyl
Previous Business on this site 641,fLAI i.,31/jG
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: 51-1626 M4,01 01:W17E cl jf/p1s' � � L- ��pe�y5
oNE s�fr�"T- ,
*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 accuratq l° best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature (� 3 ; _ Z�t'� =h'
APPRO VAIN "INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x 119.
[ ] 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 i
Zoning Official Date �
__Z1 Tjrbi / --G
Other Official Date
"'Y — 1- 111ar,e uep:rrrment or community lievelopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
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Intake to complete the following:
Y
Is i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil 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 or public water?
If private well, provide Heal t 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 Perm' .
Permit # =44-q !s
Zoning to complete the fnllnwinv.
Te ewer to complete the following:
e fo otage of Use:
N
dtted as: Pro', Jar—, �
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
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