HomeMy WebLinkAboutCLE201300227 Legacy Document 2013-10-11f4 -Cep, ry,� i4wmj
Application for Zoning Clearance 1 t
CLE #2010. 221T e=d 14s
OFFICE USg ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt#� staff:
PARCEL INFORMATION
Tax Map and Parcel: Q 1 _ 00-60- 0 1400 Existing Zoning
Parcel Owner:- Chaf-104e-4viljel Ng i_;�,f u.0--c. (eufmh'm Ghoa�)
Parcel Address: 1514q DidqrboA (U• City C6r10tf9 -W dtt_State VA- zil)7_20
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? W 614-A 14 114
Address: 5-1 K D44aon QJ city fjJJr 1 0 Ville- /State Zip 2-7q it
qoq -
Office Phone: q3q Cell # 0yol Fax# E-mail bi(,habAh& !JfKfiJ'J.MPA
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-APPLICANT INFORMATION
any that apply: _ Change of ownership _ Change of use _Change of name New business
-Check
Business Name/Type: 6AuoA RgWiRevi rl,�yjA (�M(,)
Previous Business on this site .11
Describe the proposed business including use, number of employe(Q,nunKr of s ifts',pailable parkilPgg spaces, number of
vehiclesj,'pte. and any adqi0onal information that you can provide: IcandfaAer
12FI . Wt MdV 614n h9C 4 60MOrC. �fte,
iol I I I I
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a ner V location, a netv
Clearance will be required.
I hereby certify that I own or have the owner's pen-nission 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 Printed Mttyz- IN, Rilkabquah
APPJkOVAL INFORMATION
�/Approved as proposed Approved with conditions Denied
Bac ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
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: A7)T[:t k::ki d
Building Official Date
Zoning Official I ]JU'll J4 Date
Other Official r 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
L -
Intake to complete the following:
Y /�Is a LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil sere 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 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 public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
Y /N�� luul
Will�ilere be any new c nstruction of novations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
p ri-nN itted as:
Under Section:
Supplementary regulations section:
Parking formula: ,v
Required spaces:
Y N
Ite 1 o be verified in the field:
Violations:
Y /(N
If so, ist:
Pro e
Y/N
Ifs , ' .
riance:
/N
Y f so, List:
's:
OY / N
o, List:
Cut 164
V V
Clearances:
SDP's
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Revised 7/1/2011 Page 3 of 3