HomeMy WebLinkAboutCLE200800236 Legacy Document 2013-03-18Application for Zoning Clearance
CLE # 4008 —' Z. 3G
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[p Zoning Clearance = $35
OFFICE USE ONLY
Check # / uc� Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # `7 Staff.
PARCEL INFORMATION d
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Map and Parcel: G19 6% — "- do -- 0 ( Existing Zoning �
Parcel Owner: Cn 2wk:-r ( 1 -SYcax AJ Co
Parcel Address: 314 PAN T. PS' C--(/L-.City CHA2to z7t0ViLLtState VA_ Zip234c) 1
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? J 6 CIA-7 t,VA L,?en1
Address : 3222 ,Pa PL,3r_ At; 6- 99 City ce z1Z101 "State OS- Zip 22-c( it
Office Phone: (t{ ) 2-qCa ^ S�3 Cell # Fax # E -mail 2UJA L-CW,% <n
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 8401-t 10 cu?-P d s= s rr c n� ce
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: S'A r)F Ctc2� r i Gy► �-S [ n-2�S
*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 e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed f2o_R LM-r
APPROVAL INFORMATION
I'll-'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 iii 34) le
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
Intake to complete the following:
Is u in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will 01cre 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 p is ate ?
If private well, provide Health ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a�pli
Is parcel on septic or iGfc� w r
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# "1'5 U� -Y��l � (, -2,
Willi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
.b N /
Permitted as: �4rn�A Tn,l Pnl
Under Section: „A
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
/N
f so, List:
Pro rs:
Y/
If so, List:
Variance:
Y /
If so, ist:
SP's:
Y/N
If so, List:
Clearances:
SDP's
c)5c --33
Revised 04/28/08 Page 3 of 3