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HomeMy WebLinkAboutCLE201300174 Legacy Document 2013-08-09Application for Zoning Clearance CLE OFFICE USE O Y PLEASE REVIEW ALL 3 SHEETS Check # E M Date- Receipt # Staff PARCEL INFORMATION.. Tax Map and Parcel: S C Ll Existing Zoning Parcel Owner: �" "c, i h C 4 LC,-� ,=l Parce_ l Address: � State l%7� Vo _o 000 City Zip (incivaesuite-or iroor) 0[ g) s. F PRIMARY CONTACT Who should we call/write concerning this project ?� Address : I q 5~ Tai �� �jp�cc� �JJY`1 v � Cit����sv; 111f State %l' Zip a2,g j 1 Offce Phone: (��) ���� %�'� Cell # 906-.ZS ^� Fax# �i6- 2,S l0 E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: hMh( AU_' -0 UL AfCO" � IA)6 G9c-kkP , LLB. �CS I K LCSY Previous Business on this site OCYL at1n1 K; mow. W6-,��C,,E$, « � 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: Re. WA, F, J?--IIL *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 accu Melhe b st of my�knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature "Y,ROVAL INFORMATION [Vj'Appr-ved as proposed [ ] Approved with conditions [ ] Denied [ ] B ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 17. [t^o 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 7/1/2011 Page 2 of 3 Intake to complete the following: Y /N0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /© 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 o ublic water? 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 applies Is parcel on septic or u lie sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /N0 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: l ; 8Sl S � F fitted as:. co Under Section: Supplementary regulations section: Parking formula: 1/26b h Required spaces: / r, Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/ If so, t: Proffers: Y/N If so, List: Varipef • Y /IN / If so, st: SP's: Y oc If so, ist: Clearances: Poll 1 "I SDP's ��V S of — L I Revised 7/1/2011 Page 3 of cvwQ1T A SZRTE C-5 1,851 S.F. — VIRGINIA LAND COMPANY OF CHARLOTTESVILLE, INC. 195 RUEREEMD DRIVE P.0,6098147 CHARLOTTESVILLE, VA 229U6 TS=L: j4341 979-$181 ; AX (0.3.31 296351G Yi7 INFO & %IRGINIALAYDC017PANY.COM tip i7+ir rnron. +uh<nt ra• dcrmcAw br reliably Ent Lr nul xd :nvntred. ,Inrrr t'l. 2:NI'l. __ _