HomeMy WebLinkAboutCLE201300245 Legacy Document 2014-03-27Application for Zoning Clearance
Is-.
CLEN
PLEASE REVIEW W ALL 3 SIM ETS
OFFICE USE ONLY
Check # Sys 50 Date: d /71261
Recelptg 93/76 Staff- A<_
PARCEL INFORMATION
Tax Map and Parcel: 0G 106-C>3-_00-61gAQ Existing Zoning
41"4CL✓
Parcel Owner:
4 F
St- te Zip 7.1-po
Parcel Address: F
rai
(Include suite orfloff) A
-PRIMARY CONTACT
Who should we call/write concerning this project?
city rUL:�y 2290
state Zip
Address:
Office, phone: (41" 91Y Cell # Fox # E-mail
APPLICANT INFORMATION
Check any'that apply! Change of ownership _ Change of use �Change of name New business
#tk-,
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
vehicles, and any additional information that you can provide:
11N c
which it is approved. to a now location,
*This Clearance will only be valid on the parcel for f you change, intensify or move the use a now Zoning
Clearance will be required.
ided
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
knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
is true and accurate to the best of my
Signature Printed
APPROVAL INFORMATION
Approved as proposed Approved with conditions Denied'
Back-flow prevention device andlor 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 coinpliance with the existing
site plan.
[ ] This site complies with the site Plau as of this date,
Notes.-
Building Offic Date 10
/1
Zoning Official Date -z, &4 z
Other Official Date A2 Z �T
I-ounLy Ul I-111jr,111a I it; "upil I k2l u• -, -v — -, - ...1-- .. - -_-
401 McIntire Poad Charlottesville, VA 22902 Voice., (434) 296-5332 Fax: (434) 972-4126
Revised V112011 Page 2 of 3
t
Intake to complete the following:
Y/8
Is use m LI, M or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
(�/N
Will there be, food preparation?
If so, give applicant a Health Department form.
Zoning review can not egip until we receive approval from Health
Dept, FAX DATE 7 Z Za i
Circle the one that applies
is parcel on private well or p rc wn 7
If private well, provide Health epartment form..
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or p is se
gill you be putting up a new sign of any kind? If so, obtain proper
N
Sign permit,
Permit #
/ N
' II there be any new construction or renovations?
if so, obtain the proper Permit,
Permit # , '2 o1-3�4&7 !#'
Reviewer to complete the following:
Square footage of Use:
/ N ��
ermitted as: ��"
Under Section: ,'Oe'MAy e-, PlAe, c n - )
Supplementary regulations section;
Parking formula: 5/45
vat
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
-Notes.,
4011tn ro com IUJU the LVILU IL o
Viola 'ons:
Y/N
If so, Last;
roffers;
Y/N
If so, List:
-Zlti,A Z,24- Z
Variance:
/N
f so, List:
Y/ I
If s , ist:
Ciearauces;
SDP's
Revised 71112011 Page 3 of 3