HomeMy WebLinkAboutCLE201300296 Legacy Document 2013-12-192
Application for Zoning Clearance
CLE # ZO I3 " Z 9 69
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # _STY'S Date: 12 1 I
Receipt # Staff: Dig,
PARCEL INFORMATI1ON -��-- / G
06[ 000()W K) lvsl
Tax Map and Parcel: rltwr ZZ Z ? Existing Zoning N[ Sf
Parcel Owner: haky al Al'. k�ey—
,�
Parcel Address: a?W /) � ✓�r & - -k- / City G /�iyJ� �jJ�� State % Zip
020(
(in Jude suite or fl or) 5U-,W,-0W/
PRIMARY CONTACT
Who should we call /write concerning this project? ZLIXIC
Address : 111 City State Zip
Office Phone: Cell # Fax # E -mail Gt�/�f .S� a& -4 -aX4
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
ve icles, and any additional infmation that you can provide: `�
G'
*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 o ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate tot t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
/
Signature Printed D 11t (� f =
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 j 1 (G /( 3
Zoning,Official Date
Other Official 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
2
D
n
Intake to complete the following:
Y /N9
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /if
Wil `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 applies
Is parcel on private well o public wa
If private well, provide Hea 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 ublic sewe
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
,Y IN
Waif I there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # j9,2_01-3-0/020-AC
Zoning to complete the following:
Reviewer to complete the following:
/
Square footage of Use: /00)
)t /N
Permitted as: -P 19 / aTtI
Under Section: �Z—
Supplementary regulations section:
Parking formula: l
is
Required spaces:
Y/\
Ite o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y811
If so, List:
Proff s:
Y/
Ifs , ist:
Variance:
Y /IK�
If so,- L-i"st:
Y/
If S8—' List:
Clearances:;
SDP's
t-
Revised 7/1/2011 Page 3 of 3
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