HomeMy WebLinkAboutCLE201300129 Legacy Document 2013-06-19Application for Zoning ClearanceE1�1''`
CLE # 16S
OFFICE USE ONLY �/� �'
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 06"1 UO - 63 - 66 - GNU -7-1) D Existing Zoning
Parcel Owner: Clqujee M d✓5kd
LL//�
Parcel Address: 3 oy Z &eAy+9r' �i' City C1?r4 ✓�u7Tcstli I/ e.- State �� Zip229o/
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : �b0 �t�.�tCcAt�► (`� City i'�nAt�01i�� ? . State V4- Zip279�2
SV
Office Phone: ((() 7%- 5'33 Cell # 4 3q 42 f- TISTax # E -mail ,la�k4r2 @ l4- bCrtnEk (f •alg
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓New business
Business Name /Type: Ak6km&t\A l>\,,` q F-iC4 I`8 1Q
Previous Business on this site
Describe the proposed business including use, number of employ�i es, number of shifts, available pa king spaces, number of
vehicles, and any additional information that you can provide: /+mbul"eP Service y Z , i►4 If 51 Aee5,
2 3 sewre.l
*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 own '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 w dge. I have read the conditions of approval understand them, and that I will abide by them.
,aan"d� 'I
Signature Printed 4�W i 17 iJC�G�
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 —6
Zoning Official Date
Other Official Date
County of Albemarle lieparcmeni or wmruuurLy Mt;Vn1vYA1AU1k
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:
Is/
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 or public wa r?
If private well, provide HeallB, nt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that tppublic Is parcel on septic se
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-n in to com lete the followin :
Reviewer to complete the 22following:
Square footage of Use: qJ�
j /N p
j�ermitted as: _��(u 2 541(44
Under Section:
Supplementary regulations section:
Parking formula: � f
t
Required spaces:
Y/
Item be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/
If so, ' st:
Proffers:
Y)
Ifs ist:
Variance:
If /IVi
If so, 1i t:
SP's:
If/
Ifs st:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3