HomeMy WebLinkAboutCLE200800257 Legacy Document 2013-04-05Application for Zoniinu Clearance
o�
CLE #
Clearance = $35
OFFICE USE ONLY olo
Check # `2 2. I g Date: 2, 9-00
PLEA9Zoning
REVIEW ALL 3 SHEETS
Receipt # L Staff:
PARCEL INFORMATION
Tax Map and Parcel: o 4 6 B 4 oo — d O Se(DExisting Zoning
Parcel Owner: Ry '13 r—_ J-4 i Pif--f C (A t; L
Parcel Address: tyJG ! U19ate V Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project.?
Address: 1 op rz (--DrZ65 City 4-14 r V L - State Zip�Z�!
Z n r J
Office Phone: f3 t e # �� '�S x # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: T T- J�G a&C'e,
/— "f
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
information MIS/,J—r
vehicles, and any additional that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, ntensify 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 th best ofmwledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
r
Signature Printed ? ic. Af-1 D 15. IF'E�, ctc' -2
APPROVAL INFORMATION
[ ] Approved as proposed [VApproved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 as o this da e.
/� G �... 0a [ "V W rC Mb Fbbd 5 ery i C6eas��1 e---
Notes: , . � . r� . c rs
a; r u
Building Official Date
Zoning Official Date Z4_ 6 Q7
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
V---L
Intake to complete the following:
Is/
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�N/
Will 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 priva a well or public water?
If private well, yrrovide Health Department form.
Zoning review (6 not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apVtublic es
Is parcel on septic or sewer?
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 onstruction or renovations?
If so, obtain the proper ermit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
/N
ermitted as: ,.� �� L
Under Section: rjG(�M. In F ,S`%�l V-& 0 ra ckcl
Supplementary regulation section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
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
4. as ,7 ""Y'.
p a� t vised 04/28/08 Page 3 of 3