HomeMy WebLinkAboutCLE200800243 Legacy Document 2013-03-18Application for Zoning Clearance
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CLE #� —' Z-L/
Zoning Clearance = $35
OFFICE USE ON Y n cj
Check # 7�V3 Date:
Receipt # Staff:
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION Igo
Tax Map and Parcel: Existing Zoning
Parcel Owner: S C C �i�l f 7 #/0Y
ZI Vii '��� `''�C� State Zip
Parcel Address: City
(include suite or floor)
PRIMARY CONTACT i
Nei dam"
Who should we call /write concerning this project? �✓
Address: 2 0U City tar_)_fi(1i /Ntate Ilk Zip 27LI-
/J���c c�Lr'�, sc<ap�y r�� yL'l-
Office Phone: �� Z5S• x(301' Cell # 21� 1 • V� Fax # Z)S U� 3 2 E -mail V.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use V Change of name New business
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Business Name /Type: AC-�Zv N
n r�
Previous Business on this site �-
v r
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:
13 C-1- Cv 2 & " 6 L3 Y- 7)'-11 CA_j. I
fi/i -�° (l� • � �%' ��r� L �R- r- f'U2 / c� i ✓Lk C�G:i I � �i �r rzl
*This Clearance will c ly be valid on the parcel for w ich 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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of y I wledg . I have read the conditions of approval, I understand them, and that I will abide by them.
~annd
Signature Printed �. ,aJ G► =n1��- / - b'" /�`d�
, P OVA INFORMATION
[ Approved as proposed [ -] Approved with conditions [ ] Denied
]]� prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
,,13�0<flow
,[ physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
J1
plan.
[ ] This site complies with the site plan as of this date,
Notes:
Building Official Date it
Zoning Official /V� Date (,2G 09
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 04/2
Intake to completSAI�e following:
Y /
ee in LI HI or PDIP zoning? If so, give applicant a Certified
Enginee Rep R) pa ' et.
Y/N
Will 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 Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is par I on septic or public sewer?
Y /'N
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wi e 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: �4 1 6-6-o ( o 2 3 u &O'e7t))
/N
Permitted as: k.
Under Section: A '74? - I
Supplementary regulations section:
GU
Parking formula:
13 s
Required spaces:
YY /N
Ite s to be verified in the field:
Inspector : Date:
Notes:
Viol ns:
Y /W
If so, List:
Proffers:
Y/
If s , ist:
Variance:
Y
If ist:
SP'srp• �
Y /lIY/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3