HomeMy WebLinkAboutCLE200800219 Legacy Document 2013-03-18,1�
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PARCEL INFORMATION
Tax Map and Parcel: '7 / %� Existing Zoning S r
Parcel Owner:
Parcel Address: �%� / �,){ G,� City C'i fL / tate / � Zip .2 d
(includ s�or floor)
PRIMARY CONTACT Gprir t-J t7_j1`J r;"N
Who should we call /write concerning this project? S'7�'�i/ /-Av.) 4,.,y -r
Address : G / S A7" City G Lr�`.E State �%%� . Zip �?Ol
Office Phone: Cell # s�4 -70 Fax # 6 E -mail
APPLICANT INFORMATION
Business Name /Type: /VO� NG-
�=,�m say sa
Previous Business on this site
Describe the proposed business including use, number of employees, number o , , er of
vehicles, and any additional information,that you can provide:.., 4f.4 a•
je-
*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 accura a to tjme best o my, knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
i s� �A �l.�.rd,G �Ls%U
Signature Printed Y5 • AP54P j& 4,.�_ Jf
Building Official '^'"
Zoning'Official`.
Other Official,
Date J I
'Dai
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
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Intake to complete the following:
Y /l0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y i e 1
Wre 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 public water?
If private well, provide Hea __ epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic r public sewer?
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
,A-
Permit U �� r� rX�t�iq�d si6�v
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ^ ,6,2O0.k / -/G3h4
7.nnina to vmminlPfP tha fnllnwinST_
Reviewer to complete the following:
Square footage of Use: %a Od �SQ4�
Permitted as: c�Gi/t b ✓? L. i"c - /(t
Under Section:
Supplementary regulations section:
(4ia
Parking formula-
Required iyt.c C'►' .
Required spaces:
Item o be verified in the field:
Date:
Viol u ions: v
YPist:
If
Proffers:
Y. /
If ist:
�
l
I
I
Va ' �ce:
Y
Ifs , List:
SP's:
Y/N
If sAist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3