HomeMy WebLinkAboutCLE201300240 Legacy Document 2013-12-27l
Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U LY
Check # Dater
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 06100-01-00— 0/500 Existing Zoning C—
/
Y'I
Parcel Owner: (i vi ace- L—a A,11( 7 rtl s (-
Parcel Address: 21 ( I 6ler(ClUetr [—')f- City ChM-'1p -(f'C -SU, /1eState VA Zip Zzwi
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue- . A, A f6- e —r-wr
Address: L55 5=T c5, (-Ctt ��G(GG- City ���/rq�`p State (� Zip ZZ�d
Office Phone: (W Jam{) 53 j 7,L13S Cell # L6q-5 3l -' Fax # 1- -075 E -mail 5a e(q) &-5i go ea V,'Ivas
Tom( 35
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: I' I l i eC' �" /`cV +0
Previous Business on this site 7RfL(-k,e-<-S A ,[Ai
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 > ItGE'S
o lc-Ks
*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 "' ac cu e to the best of y kno edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
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 "�- v Z
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
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Intake to complete the following:
Is /
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/9
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Hea e artm form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a lies
Is parcel on septic k public sewer?
Z /N
ll you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
WA
-Will there be any new construction or renovations?
If so, obtain tlie'proper Permit.
Permit #
Zoning to comnlete the following:
Reviewer to complete the following:
Square footage of Use: 25/t, O
6/ N L
Permitted as: � o I✓fi i K
Under Section: -2- •?
Supplementary regulations section:
Parking formula: 2/
SeY��
Required spaces: , l
Y/9 `
Items to be verified in the field:
Inspector
Notes:,,
Date:
Violations:
Y /0
If so, List:
Proff rs:
Y/
If so, ist:
Variance:
Y/
If so, ist:
SP's:
Y/
If so, ist:
Clearances:
SDP's
e)00— 2.25
Revised 7/1/2011 Page 3 of 3