HomeMy WebLinkAboutCLE201300065 Legacy Document 2013-04-24Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U E O Y
Check # Date: 4
Receipt # Staff: J
PARCEL INFORMATION Z --L
Tax Map and Parcel: 7 Existing Zoning
Parcel Owner: A� t-Y..; J�u ���/ e ►�
Parcel Address: 2-yo� P; re r�lj %�dtl� City hy9%'�o C �, State �� Zip 22 /6
(include suite or floor)
PRIMARY CONTACT �pL
Who should we call /write concerning this project? At
Address : 0 2 P1QeKS P °w City Ck"IaOS Jd State ( ,& Zip Uf0 7—
Office Phone: q5 ztiZ 6 ? Cell # Ste— Fax # E -mail CLI 5dd4.A
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name dZ New business
Business Name /Type:h�i lla It l�1CJLaSSe� ,�►tC
Previous Business on this site Ii/OAle..
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: ofpj&
*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
- Signature 4yc0(&� Printed AIM" �• Sfi� 1 LE2
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
`[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 Zy23
Other Official Date
County of Albemarle Department of t ommunity Levewpcne,u
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
O/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / TAI
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 blic wa� t
If private well, provide Healfh-D artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or lic 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 construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to ommnlPtP the fnllnwinor'
Reviewer to complete the following:
Square footage of Use: 34.)
IN ��.
Permitted as: 04-' ) w
Under Section: 1--7.-2 •'
Supplementary regulations section:
Parking formula:
Z(> 1)
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
LV /N
If so, List:
Proffers:
Y/
If so, ist:
Variance:
Y /01
If so, List:
SP's: ,
Y ItR)
If so`,-]�ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3