HomeMy WebLinkAboutCLE200800260 Legacy Document 2013-04-05s
Application for Zoning Clearance
�_� °�`'
��r
CLE # abbgpC7 o��Zi
m
��RrtN�D
OFFICE USE ONLY
❑ Zoning Clearance = $35
Check # �'t'�E� Date: % lam;
PLEASE REVIEW ALL 3 SHEETS
Receipt # '% 7,.- �'3a Staff: trS
PARCEL INFORMATION
Tax Map and Parcel: d 7S 6b 06 "-66 " bi '7 O Existin g Zonin �
Parcel Owner: \-4,1 �V C .� L 1 ,/ n
Parcel Address: 5 6� 1;R � � k) 2 • s City AA Ifq 0 State Zip da Id
(include suite or floor)
PRIMARY CONTACT
1) 6 iJ K) A _b 4 A
Who should we call /write concerning this project? < V
Address : 2ir 69A" i4a 18 ° City tALVejq State /a- ,�a9ll
Zip<R@90
Office Phone: Cell # y3q._q Z _qq6 kax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Changee of name ✓ New business
_
`
Business Name /Type: ' J y yV P A' S IJ141 � :5 ktA10 A+ A10 __ 01 's
Previous Business 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 ac to the best of my knowledge. I have read the conditions of approval, and I understand them, and trhat I will abide by them.
\curate
Signature Primted 0 ti Vj A V' 1 iii
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ . acicflow 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 determination 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
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
r..
Intake to complete the following:
Y
Is L n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 1 .tl
Wil re 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 ublic Ovate
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap 1
Is parcel on septic publiclic s
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 construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: / 7 Ja jj' n
e N ��y 161 °0
ermitted as:
Under Section: �Z_j. L,
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If
If so, ist:
Proffers:
Y/
If so, ist:
Variance:
Y/A
If so, ist:
SP's:
Y/CD
If so, List:
Clearances:
SDP's
rl ��
Revised 04/28/08 Page 3 of 3