HomeMy WebLinkAboutCLE200800235 Legacy Document 2013-03-18Application for Zoning Clearance
is
CLE# ZOO 2 �S�
Zoning Clearance = $35
OFFICE USE ONLY
Check # �/�2 'J� Date: �� `� '
PLEAS ALL 3 SHEETS
Receipt # -72,973 Staff-
PARCEL INFORMATION l / �/��
g ,fin �, n
� yy � �� 12
Tax Ma and Parcel: (5 $��, �} 2 — 0 l — CJO — c�2cid'� Existing Zonin �1lLl� /�
Parcel Owner: CAIo zL-r .S�WptoI n�j C67,J7M%) L IX
Parcel Address: 9'7L&- f t &Q-4e Nc'zcp- RKCity C'ao 2.a 7 State k/b- Zip 2,r1.`i 3 Z
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �D 6MI (AIA C.TG-�
Address: 3Z21- ('b P LhA- /A-i j�jfc R& City Cjj A.R. to 77c i%(j4L State L Zip 2 611
Office Phone: `( 3`I) '2-9 ^ 5t3) Cell # Fax # E -mail ,Q W A < 0& S
® JIL�cm�k-LC-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /30'1 SW uts G1= �� c 9 � S�� °Ne wnc,-
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: ,EAU: CJF Gcfn.k sire -s
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 _ //� q�j � Printed RaVif+2.7
APPROVAL 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.
[ ] 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
Zoning Official Date
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
Si
Intake to complete the following:
Y/
Is us . LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/ N
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 er?
If private well, provide HektPq5artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies —..
Is parcel on septic o public se r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # C"� /u 9- � ll o
Y
W1 there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
N L
mitted as:
Under Section: �,Q M ,n✓7✓dq ��+
Supplementary regulations section:
Parking formula:
Required spaces:
Y/-
Ite s be verified in the field:
Inspector : Date:
Notes:
Viola ons:
If
If so, List:
Proffers:
If nN
Ifs , ist:
Varian ;e:
Y /pV
If so, List:
P 's:
Y/N
f so, List:
O
v�-
Clearances:
SDP's
C, 2—
Revised 04/28/08 Page 3 of 3