HomeMy WebLinkAboutCLE200800240 Legacy Document 2013-03-181
Application.. for Z nin Clearance
CLE i
�gNaN�P
OFFICE USE O Y `
Zoning Clearance = $35
Check # Date: /`'�1-1d
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION.
Tax Map and Parcel: 0(0/00 _00— "-1,-W,40 Existing Zoning C
Parcel Owner: g(D YWOPPL S
/(„G��y Rt,;? 1�
Parcel Address: 1,?IU City State Zip
(include suite or floor)
PRIMARY CONTACT _
Who should call /write concerning this project ?l
{we
Address :PC) City State y Zip •
Office Phone: s( o) J 2 -3 )�� Cell # SVS- N `1433Fax # SkU °i l - )'27 E -mail ,WA7W, \ ) l��i ?. - -� l • e cn���
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Name /Type:
Business
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:
*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,tme.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 Printed es 1'�_
r—
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 i
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
Od
1
Intake to complete the following:
Y /
�
Is us on LI, HI or PDIP zoning? • If so, give applicant a Certified
Engineer's Report (CER) packet.
N n
WMI there be food preps at. L?
If so, give applicant a Health Department form.
Zoning review can not b 'n til we receive approval from Health
Dept. FAX DATE j �T
Circle the one that applies
Is parcel on private well public water.
If private well, provide Hea t epar ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap '
Is parcel on septic r public sewe .
Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# OD ��0�76 .S
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit`
Permit # S S 17 J
b
ZoninLy to complete the followine:
Reviewer to complete the following:
Square footage of Use: / 1r7 o o
Permitted as:
Under Section: )4" 4t
Supplementary regula I on
s section:
DC^
Parking formula:
f3/ I DO C)
Required spaces: y�
Y/N y�
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ions:
Y /
If so, ist:
r fers:
Y / Nv/ (1�51F l4
o, List:
Varia, ce:
Y/
If so, ist:
SP's:
VS/0, N
L I A:�j
Cleara so �yy v
SDP's
Revised 04/28/08 Page 3 of 3