HomeMy WebLinkAboutCLE200800252 Legacy Document 2013-04-05Application for Zoning .�..Clearance
CLE # 27 a
OFFICE USE :ONLY
-Zoning Clearance =��$35 .Check #. 1' ��-- Date ., ) "
PLEAREVIEW ;ALL 3 SIiEETS . Receipt "# ✓� 2Cfl Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning �,l%SL
Parcel Owner: d"
Parcel Address:—S:�2 L/ R4./4& -, t ,J7 & City J z State Zip de) A
(incl��udee R ite or floor)
PRIMARY CONTACT �
Who should we call/write concerning this project? 924'rC4.r 'ee'!%/;/f
Address : rjg:�/ 9 City e, State 644 , Zip as
Office Phone: g1joe) Cell # t'GG' %G Fax # i� /'S�% E -mail
APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site C f ;e` 6A ff-fir
Describe the proposed business including use, number of employees, number of shifts;
vehicles, and any additional information that you canProvide: Ift /401P �nC -✓
C44-3
*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
Clearance will be required.
of
a new Zoning
I hereby certify that I own or have the owner's percussion to use the space indicated on this application. I also certify that the information provided
is true and accurate t • the best of my wledge. I have read the conditions of approval, a d I understand them, and that I will abide by them.
Signature / Printed �AJ
Z.onm Official `
g.
`O'ther' Official
D
ate
County of Albemarle Department or Uommumty lieveiopment
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:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil 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 p
If private well, provide Hea 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 public sewer?
Y/6
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 14)1,// C.cxz * jJZ NG- �%ti
Y/N
Will there be any new construction r renovations
If so, obtain the proper Permit.
Permit# 19 A C,
7nninar to emmnlPtP the fnllnwinu:
Reviewer to complete the following:
Square footage of Use: 3 o7 O U
N C� Q/�--F a'l 1L��Y�CJ
ermitted as: !ib 1
Under Section: P! J -
Supplementary regulationO ion:
Parking formula: .�
Required spaces:
Y/N lJ��
Items to be verified in the field:
Viol4 ns:
Ifs , 'st:
Proffers:
Ifs c t:
Variance:
If s C J t.
f
SP's:
Y /�
Ifs , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3