HomeMy WebLinkAboutCLE201300228 Legacy Document 2013-10-17Application for Zoning Clearance
CLE # Zb l �) - 2 2,6
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 2505 Date: G
Receipt # Staff:
PARCEL INFORMATION �7 i2. /0
y 2 Existing Zoning /`t
Tax Map and Parcel:
Parcel Owner: Lax Assoc
Parcel Address: T V-4-GlL City C b_ , (p(J W State �� ZipZ ZL o
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address:- o Js �OK�` �— �r�L�— city _kr1oth VW11-- State ��- ZipZ_ Z" Ci
Office Phone: 45` of Cell #-43+ ?S3-6o0 f Fax # fi r/6 ? E -mail
r-c�CS • GEC`-'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Sf
Previous Business on this site i4 i,,l
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: Te�f_�
*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 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.
QQ
Signaturel � _fzz Printed �� 16 der -/�Ie_ ` -
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 c Date't
Zoning Official < Date zl Zo�
Other Official Date
County of Albemarle Department of Community ueveiopmeni
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
0
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
91
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be i until we receive approval from Health
Dept, FAX DATE 6�
Circle the one that lies
Is parcel on rivate well r 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 a plies
Is part n sept' public sewer?
Y/
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
,1)/ N
Permitted as: ��� 1 ►��G�
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proff rs:
Y N
If so, ist:
Variance:
C/N
If so, List:
SP's:
Y/N
If so, List:
`7�- 32-
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3