HomeMy WebLinkAboutCLE201400044 Legacy Document 2014-03-19Application for Zonin Clearance
CLE
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 13 % 7 Date: .3 11 y 1 V
Receipt # Staff:
PARCELINFOR 00,:200 Tax Map and Parcel: ` o,900 —ml 0610DO90C Existing Zoning Z4'
Parcel Owner:
Parcel Address: %�?5 r` J` y1r/y� %i'(2�� City 4 mY&�TC'Si'1��¢ State Zipjag,
(ine'tutfe suite or floor) '
PRIMARY CONTACT
1�n L ( �� �/ �L%✓ ?S
Who should we call /write concerning this project? LM i2U- Y (�
Address: (371 CILshimAtv &I City �/(-%y� State I° /� Zip �Wos
Office Phone: (g�)75.1 -66,5.q Cell 305- 7777Fax #Qy- 75d -6q-HE -mail
kr / � c6L5 7�, N
APPLICANT INFO ION
Check any that apply: Change of ownership Change of use Change of name New business
1
Business Name/Type: rnQ-CI CO"
Previous Business on this site AJO MQY\JOLQ_._
Describe the proposed business including use, number of employees, num er of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: &) C) (? Ct A) Cif
*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 ace ate 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 42
_
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 thvsite plan as of this date.
Notes:
Building Official Date 3 I 1 I r V
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
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.
Y/Oere Will 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 u lic ater?
If private well, provide Healment form.
Zoning review can not begin until.we receive approval from Health
Dept. FAX DATE
Circle the one that app.li
Is parcel on septic public sew r?
Y/N
Will you be putting up a new sign; of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonina to complete the following:
Reviewer to complete the following:
Square footage of Use: 3 9 0
9/N
Permitted as: My ��.�1��,� ►ral
Under Section: 2-2
Supplementary regulations section:
Parking formula:
4;�60 04 9 testy Arm
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol � ns:
Y /l:)
If so, List:
Proffers:
Y/A
If so, ist:
Varia ce:
Y /(N
If so`List:
�),s /
If so List:
Clearances:
SDP's 9 ��
Revised 7/1/2011 Page 3 of 3