HomeMy WebLinkAboutCLE201300025 Legacy Document 2013-03-27' It wan ed rnaNt, per,
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Application for Zoning Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # -7m Date:
Receipt # 4 Staff:
PARCEL INFORMATION n ,��� n ,/e p ,
Tax Map and Parcel: i C� 12- - Existing Zoning P h�.iJ I iJ�U f _
((Lp
Parcel Owner: Vll iV) 1Ll.d +yr5
Parcel Address: 05 15a Y—vo-Y 1puy-� City U aylol udle, State VA ZipZZ�D
(include suite or floor)
PRIMARY CONTACT / � C
Who should we call /write concerning this project? Li Y?4w l c(ri'D
Address : %1 Cenh2l �k- �i1��i l`I � D Q City �2 _ADbn1 State T�) Zip / y2c�
Office Phone: Z y9- IgAell # Faxil 1093-' I � t E -mail � I Yi g iaq . G ci3ay �.
ourros►;. coyy
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
/Change
`
Business Name /Type: �I Y a�,
Previous Business on this site
Describe the proposed business including use, number of employees numbe of shifts, available parkin spaces, nu ber of
vehicles, and any additional information that y u c provide: Q oy-vi 2 it Y —
►� r b ' e- a02-
*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 ahem, and that I will abide by them.
Signat Printed Uej Sx),A QY�Q
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 r 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 7/1/2011 Page 2 of 3
f p�� ,
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 o ublic wa er?
If private well, provide He ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or is sewe "r.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there 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: 2.2-0 b
0/N
Permitted as:
Under Section: 1-J �' I
Supplementary regulations section:
Parking formula:
7J�
Ity
Required spaces:
Y/
Item o be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/(,
If so�i``st:
Proff s:
If/
If so,`�ist:
Varia ce:
Y/
If so, List:
SP's:
I' /N
If so, -List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3