HomeMy WebLinkAboutCLE200800245 Legacy Document 2013-03-18Application for Zoning Clearance`°
CLE # 7,00
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OFFICE USE ONLY
Lb 7o
Efzoning Clearance = $35,
PLEASE REVIEW ALL'S SHEETS
Check # Date:
Receipt# 7 �i l Staff: AA
PARCEL INFORMATION
Tax Map and Parcel: C 5Q()-OCR -D (7. o,,q A -C� Existing Zoning Sh 7oyr�,
4.
Parcel Owner: 9&w SC: �)EQ) New ti_q J -& n
, MPM,+
Parcel Address: g2 U �0 �� I Qn'�/t 54,-69-Li City 11�-_60; Ile- State VA Zip 27i0 I
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 2011 1)�00 "YOOk 02 City \;V\Lt WttS:O' _ State VA Zip ?gnc
Office Phone: 7( 37) Z Z0'31 2(2 Cell # V-Td' 17YLPFax # 43V' 270'?1 &8 E -mail _j�lGcrz,. • I,. LJklloyt (J2
APPLICANT INFORMATION
Check any thatapply: ` Change of ownership Change of use Change, of name New business=
Business Name /Type: l "� ' 1'7 ✓lCtl -�G� Gl
Previous Business on this site )IA ) V)
Describe the proposed business including use, number of employees, number o shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: Pi % CQ,o•
- ova: c� l,� ` •. shv � - Z '�� d
*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signat a Printed 'zXG1n/ ab l io Y,1
APPROVAL INFORMATION
[VI Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119:
[ VNo 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 I -41 .'
Zoning Official (/1/'G Date 1 l I1`% 111
1
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 / /�
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /IV
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 ublic water?
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apppcs-
is parcel on septic or Oublic sewer
Wi4ol be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /N1
Wil here be any new construction or renovations?
If so, btain the proper Permit.
Permit #
Zoning to complete the followine:
Reviewer to complete the following:
Square footage of Use:��
R.
Perm tted as: ��
U� �
Under Section: a6'A 4 42 1 l�
Supplementary regt#ations section:
Parking f� (
Required spaces
Y /N
Items to be verified in the field:
Inspector �, Date:
Notes:
Violat' s:
Y/
If so, st:
Proffers:
Y/N
If so, List: y0 d 3
Variance:
Y / IN
If so,`Y ist:
SP's:
Y /
If /ol ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3