HomeMy WebLinkAboutCLE201300091 Legacy Document 2013-11-08F
Application for Zoning Clearance
CLE # 961,3
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 7 5'4 Date:
Receipt # D Staff: ,VT_�5
PARCEL INFORMATION q J
Tax Map and Parcel: d.3 O " 66— 00 P 0 � Existing Zoning Gy G6rr�iv�f (� SG 1
Parcel Owner: »' rL
Parcel Address: �.� DD E (.t/�l.11�0) `� _�O�rty �� `�_ State '1� Zip
(include suite hr floor)
PRIMARY CONTACT
ko e1e-t'
Who should we call /write concerning this project?
Address C i�� �I�X'2� fib I 6cAL6V_%1 HCity G_ State Zipu -l�J l-Q
Office Phone: �� Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name 1--'New business
1
Business Name /Type: d�l,'� (Jti `�- �1 � Y —Vi t LUL (Y-gat C
Previous Business on this site FcLrL ll<1 tt
Describe the proposed business including use, number of employe s, number of shifts, available parking spaces, number of
' IQ- i
vehicles any additional formatioonthat you can provided ejr�j C � t � �� rne
and
*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 y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Y-4_6� Printedl�
Signature A
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 iCAz �Z��
Other Official Date
County of Albemarle Department of Community imveiopment
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/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/qWill t ere 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 :al,,!'es
Is parcel o ivatI r public water?
If private wel , p ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one hat applies
Is parcel o epti. or public sewer?
N
VAh you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will Ire be any new construction or renovations?
If so, obtain the proper Permit.
Permit # — V OU
7nnina to rmmnlete the fnllowinu:
Reviewer to complete the following:
Square footage of Use:
(S /N
Permitted as: Vi Al-. C, dA A� a'
Under Section: I --11— `2- , I
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
®/ N
If so, List:
Proffers:
Y ���
Ifs ,-list:
Variance:
If so,Zist:
SP's
If so,'�ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3