HomeMy WebLinkAboutCLE201300070 Legacy Document 2013-05-03f
Application Zoning Clearance
CLE 10
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE NL�,Y
Check # �I Date: l�
Receipt # Staff:
PARCEL INFORMATI . ��r
VufoJ
Tax Map and Parcel: Existing Zoning
Parcel Owner: w192t"`�I�GR/S �SSOC�
f
Parcel Address: �C�e- City d /o State u Zip Z-7-q°l
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project ?
P a 6b S�(g'l City �( �0t�eSVifCc- .State �t4- Zip Z-z" ?�
Address : ?c Y
Office Phone: ( -f�`i) .2-f 3 4376 Cell # �3� 600f Fax # E -mail W �ce
APPLICANT INFORMATION
Cheek any that apply: Change of ownership Change of use _Change of name New business
Business Name /Type: �e7 t��e� (2rA< -(+)C
Previous Business on this site IU�
I
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 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 ..- sc Q.�- Printed — e 8 _t(o �te'r'
APPROVAL INFORMATION
APPROVAL
'r.;71 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 l... Date (Z 1 C Z
Zoning Official Date
Other Official Date
County of Albemarle mepartment of t— ommumty meveiuhiue-
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
�,Cp-
Intake to complete the following:
Y/N
Is use in LI, I-11 or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0/N
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 apalies
Is parcel o private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the Wit, it applies
Is parcel o septi or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Wilt re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to rmmnlPtP the fnllnwina-
Reviewer to complete the following:
Square footage of Use:
O/N
Permitted as: (P-
I (), ,
Under Section: 5P -7 -9-5
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Ite to be verified in the field:
Inspector:
Notes:
Date:
Viola��tTTi''ons:
Y/O
If so, List:
Proffers:
Y 1A
If so'-,-List:
Vari`a�ce:
Y /0
If so, List:
SP's:
/N
f so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3