HomeMy WebLinkAboutCLE200800254 Legacy Document 2013-04-05PRIMARY CONTACT
Who should we call /write concerning this project?
Address :22-- r� Elnf 6rctl/ d - (T City & I M110t4/d State V7 Zip
Office Phone: &Q24) --kq - /�S well # 004 3301" Cx # E -mail I' "I ,,�Lf -!q l� I Y��ii' v
APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site t/l bi/L R
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
vehicles, and any additional information that you can provide: S� v f'IA iyr CF��r 'r- Y re!A4 ct r,-,,A+
*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 percussion 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.
Signature f L- G� Printed
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 us�t 1, 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<aub<lic water
If private well, provide Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o ublic sewer?
U(Y N you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # alvY&O "10 P "MV/Vei`'li
Y/N
ill there be any new construction or renovations?
If so, obtain the .prope Permit. r
Permit # —10b 0J "I
7nnin4 to emmrilPtP the follnwinor:
Reviewer to complete the following:
Square footage of Use.
/ N
7�
ermitted as: e �'+`
c 1 i-'s -new
Under Section: . r2l 2- 1
Supplementary regula� section:
Parking formula:
Required spaces: p�
Y/N
Items to be verified in the field:
Inspector:
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:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3