HomeMy WebLinkAboutCLE201300157 Legacy Document 2013-09-19Application for Zoning Clearance,�1,_
CLE # -
IYIiGIN�'�
OFFICE US I O Y -1-2 4, -2)
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMA IrrOa 1 (�
Parcel: �'J� ' -^ I Existing Zoning_' X
Tax Map and
Parcel Owner: ,12 , %-
Parcel Address: SE j�' D 7 Z City ePAl9&ghEEi'lL82L Late 114 ZiP'z29G'/
(include suite or floor)
PRIMARY CONTACT ,
Who should we call /write concerning this project? M-- S L L
Address: City e' LJLU f_ State VW Zips/
Office Phone: Cy3ji 9'7.x . �J Cell # 330- �O)VFax # E -mail C,tt.�/JStr Gt�i��ci✓ia _ .NAT
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �% ✓ 2
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: ,C tlb,-7�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 the ow a 's permission to use the space indicated on this application. I also certify that the information provided
nowledge. I have and I understand and that I will abide by them.
is true and accurate to tl of cl read the conditions of approval, them,
Signature Printed��%
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 —717_91-)'0)3
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
qllq 113 i
(J ( Revised 7/x/2011 Page 2 of 3
C
Intake to complete the following:
Reviewer to complete the following:
Y /(Y Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 0 / N
/ Permitted as: r�
Y /(lN t
Wil re be food preparation? Under Section: ��. 2!
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section: A r
Dept. FAX DATE 1
Circle the one that applies Parking formula
Is parcel on private well or public water?
If private well, provide Hea 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 o rpub�lic sewer?
iY )it N
ll you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
®/N
Will there be any new construction or renovations?
If so, obtain he pr er rtnit. ) �� 21 �
Permit #
Zonin to com lete the followin :
Required spaces: / r,
Y/ N (N
Items to be verified in the field: C,
Inspector:
Notes:
Date:
rolations:
/N
If so, List: I
Proffers:
If sb, -tist:
Variip e:
Y/W
If so, List:
SP's.
Y /(`
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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