HomeMy WebLinkAboutCLE201200252 Legacy Document 2013-03-27Application for Zoning Clearance
CLE oi-
OFFICE U Y f� +
Date:
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # Staff:
PARCEL INFORMATION-- -
Tax Map and Parcel: MI � Exi ting Zoning �
U�4M3�b 4
Parcel Owner:
�o1i Stn D 2U S i city f!�U 0SVII'2 State V � Zip c3acO1
Parcel Address: Y
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �2-0
Address : to 1 ?-A �yY e rC.V'2S� AV'e ' City L4L - ()C)d State (2-A Zip�Q�t3
Office Phone: 63%n),40-4 —(Cell # Fax # E -mail Vrr'merc2a-�
�pr'rn i g
APPLICANT INFORMATION -- - - -- — - -
Check any that apply: Change o�f� ownership ,-New business
Ch.aannge, of use Change of nam�+e)
j�
Business Name /Type: 14 a/02 r `�I y+ / ��
� p
�'� 1 IN Mw &K
Previous Business on this site
Describe the proposed business including use, number of employees, numberppof shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: iiP� -i l
*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 accurst to the best of my kn ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 4LOW4 -- " �--
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, x117.
[ ] 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�L��y�3
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 7/1/2011 Page 2 of 3
Intake, to complete the following: Reviewer to complete the following:
Y N% Square footage of Use: 1 �j
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
Oermitted as:
WiIC2re be food preparation ? - - - Under Section: -
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is_parcel o- private well or licwate?
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 ap '
Is parcel on septic rMjgUSCLs.
Parking formula:
bS 660
Required spaces:
Y /1N
Itelir� /
ist be verified in the field:
Y/N
— Will you be putting up anew sign of any kind ? -If so, obtain proper
Sign permit. /
Permit # Inspector
Y/N
Will there be any new construction or renovations?
If so, obtal he ropy Pei
Permit #.%
;,,.: + la +a +ha fnllnwina-
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
'If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
MIA—
Clearances:
SDP's
WIN -
Revised 7/1/2011 Page 3 of 3