HomeMy WebLinkAboutCLE200800258 Legacy Document 2013-04-05Application for Zoninu Qearance
CLE # !� `�-
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Zoning Clearance = $35
OFFICE USE NLY �/ • x�
Qw � Date. V
PLEAS VIEW ALL 3 SHEETS
Receipt # "1 �(0 Staff: XCI
PARCEL INFORMATION / n
/0/ / Z3
Tax Map and Parcel: / Existiing Zoning %�,//�
Parcel Owner:— j/j ,4�Ciiftij �;/ti,'iC�X �f� t0
yS/�►,
Parcel Address: >; A /�,-�ANju ��. City C� ?Idb State 144 Zip Z�po
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
[
Address : J �% Lq-)�_4 .V- City tate
Office Phone: �`r�Cela.# Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
I
Business Name /Type:
Business
Previous on this site
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:
*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 t the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by ahem.
Signatu Printed ��a �Q /� , �d j' \
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APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 plan as of this date.
Notes:
Building Official Date t
)a.1
Zoning Official Date /� // n /p�
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
0
M
Intake to complete the following:
Y ALI, Is HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Will e 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
Reviewer to complete the following:
Square footage of Use:
P /N
ermitted as: Z,- 1401rr- Q VGA✓'
Under Section: 4&A-. ,1 r6d *{£
Supplementary regulaf ction:
Circle the one that applies Parking formula:
Is parcel on private welloy^,'Jn? G
If private well, provide a �ffltment
Zoning review can not begin until we receive approval from H6al'6-� Aequired spaces:
Dept. FAX DATE
Y/
Circle the one that a P li Items to be verified in the field:
Is parcel on septic public sewer?
�)7 N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permits
Permit # 8 Inspector : Date:
1, /� Notes:
Will t Zere be an new construction or renovations?
If so, obtain the ro er Permit.
Permit #
Zoning to complete the following:
Viol t, ns:
Y %N/
If so-"List:
Proffers:
Y/
If so, List:
Vari ce:
Y /(
If so, ist:
SP's:
/N
f so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3