HomeMy WebLinkAboutCLE200800256 Legacy Document 2013-04-05Clearance
Application for Mnln-9(0
CLE #
Zoning Clearance = $35
OFFICE USE ONLY
Check # J%Q 2 Z) Date: 2 'D yOO
PLEA E REVIEW ALL 3 SHEETS
Receipt # 4-( Z Staff: <J
PARCEL INFORMATION /�
Tax Map and Parcel: ''4rj l'� - 0(0 - l S ExistingZonin 41,,kWr�.•/ CDVY)r erC,;v.
Parcel Owner: 1 V E'R51 Dl: C9'ROt�t 1� L_! C.
Parcel Address: 2331 Semi r'ol'e- Lane s j ,� City C,Ve 11=- State �/ 1 � Zip 2zgol
(include suite or floor)
PRIMARY CONTACT
" 1 !�
Who should we call /write concerning this project? P.id 1 ►Ul�p
Address : Wo' ?rCg-r0-n OANe -.,Swl A-'&o City Lev 1 State y ! Zip Z2-'i02.
Office Phone: �i834) S 17 -17A0 Cell # S&O Fax # $1.7 -'12 -4 `J E -mail re; A. rY1 "rp�n y c�
APPLICANT INFORMATION
Check any that apply: Change of ownership __X_ Change of use Change of name New business
Business Name /Type: —rqT'IAL ?CR(--ofe-M ANC..G S -Po?9"r5 Ps WCD T:'rrN E--s 'F rr'N C-SS
Previous Business on this site Awrl mue'g5' MALI—
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: Syor'ts Arcki n 4 �: 1 -viesc rr►�lOt�GAS
1 S h 1-9 #- , 100 + �ar�c -i n� s ,yovc e�� Lo V e.1.,i e1e S
*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 die best ve read the conditions of approval, and I understand them, and that I will abide by them.
1 0aa ?r
Signature i Printed
AP ROVAL INFORMATION
IApproved
[ Y] as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennination 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 8
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:
Y /
Is u e in LI, HI or PDIP zoning? If so, give applicant a Certified
Engi�leer's Report (CER) packet.
Y/0
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 or pu e w er?
If private well, provide Health bepadment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p blic se er?
Y/N
Will you be putti a new sign of any kirnd? If so, obtain proper
Sign permit.
Permit #
Y/I'll
Will there be an ew construction or renovations?
If so, obtain the pr er Permit.
Permit #
7nnina to emmnlPtP the fnllnwin (Y:
Reviewer to complete thJe follow(i gg..
Square footage of Use: ! 000`
l N I 1-116,011) t-�+?
ermitted as: lktc( d-r a Yj� �(
I,
V-e C r A 19
Under Section:
aq I ,
Supplementary regulatiogs section:
Parking formula:' /1^
Required spaces: v�
Y/N
Items to be verified in i�t1 eld:
Inspector:
Notes:
Date:
Violations:
Y/
If so t:
Proff
Y/
If so, List:
Vari ce:
Y /\N
If so, ist:
SP's•
Y/
If st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3