HomeMy WebLinkAboutCLE201300239 Legacy Document 2013-10-08Application for Zoning Clearance
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CLE #
OFFICE US ON
PLEASE REVIEW ALL 3 SHEETS Check # US
Date: �� .4 ' 1
Receipt # =D42�_ Staff:
PARCEL INFORMATION , /�
Tax Map and Parcel: _ 1-10 )/'t nI Existing Zoning i� ba d y'l(P I )
Parcel Owner;—
Parcel Address;_157 Li `� -�� � City t/l{w to _ 1� /� Zip 2 2 9
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? ? L6LL\m I.ti e: ..A -r ASHJISJ )� r
�t r
Address : 1-! o) 6goA-� tfraz t,r,,s, RN City _- - tS2 U1 t_r ra- State N , y , Zip } 1 $o
Office Phone: (L439-71S- .1713 Cell # Fax # (631 E -mail a I< Slahh 9 iQ s baa,U .
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: n N
Previous Business on this site \ P, A Q 11 r, /� .n E e 1 6 Q , sr - ..., ^ _ /t.. ;, r._
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: S'Fn%fic A e, f- x t e -ri,v r, .
*This Clearance will only be valid oil 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 tile owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and acct ate t�the est my knowledge. I have read the conditions of approval, andffI understand them, and that I will abide by them.
Signature lh � � Printart 1-) 4 l � e-% 1 9 r, 1 '-,,
APPRO VAL INFORMATION
kJ Approved as proposed [ ] Approved with conditions [ J Denied
[ J Backflow prevention device and/or clirrent test data needed for this site. Contact ACSA, 977 - X1511, x 117.
[ J No physical site inspection has been done for this clearance, Therefore, it is not a determination of compliance with the existing
site plan,
[ J This site complies with the site plan as of this date.
Notes:
Building Official Date (--1
Zoning Official Date, lib
Other Official 4t,�.a � i,�,. -tG F{_ Date _ 1 y I `6 �ao ( '
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA22902 Voice; (434) 296 -5832 Fax: (434) 972 -4126
Revised 711/2011 Page 2 of 3
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Intake to complete the following;
Reviewer to complete the following;
Y / N Square footage of Use:
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Brigineer's Report (CER) packet, () / N , 2
Permitted as:
/ N
ill there be, food preparation? Under Section: 2 , Z'
If so, give applicant a Health Department form,
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept, FAX DATE
Circle the one that applies
Is parcel on private tivell or ublic at r?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app e
Is parcel on septic c&ilblie see
Y /N'�—
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/l
Will there be any new constntction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the
Yl
If so,
Vari ee.
Yl
If so, List:
Clearances:
Parking formula:
Required spaces:
YI
Items to be verified in the field:
Inspector ;
Notes:
Date;
Proffers;
Y/
If so, :st:
SP's .
Y/
If so, List;
SDP's
Revised 7/1/2011 Page 3 of 3
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Sbarro CREARVE� IWUSMIES INC, 10
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Charlottesville, va vqin;a ad 101JI&B
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771- A #10/04