HomeMy WebLinkAboutCLE201300208 Legacy Document 2014-04-11Application for Zon* Clearance
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OFFICES NLY a
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PLEASE REVIEW ALL 3 SHEETS
Check # Date: _
^ cr o -0 -0O -- e):'1,106
Receipt # Staff- ZX
PARCEL INFORMATION
Tax Map and Parcel: 0 &1 CIO --00 - 00 - 1 jr (' 1) 0 Lor A % Existing Zoning 600 m of 4/
Parcel Owner:C� (7 LLL
Parcel Address: City G "' V 1 ° State VA Zip o2 0�1
(in dude suite or floor)
PRIMARY CONTACT G
Who should we call /write concerning this project?
-
�f fi 5 ��}��n �/1 ��
a
Address: ! I City State I/ d / zipl
Office Phone: 3' 1 13 _ "l ��3 Cell # 7,41 - I W Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
, >
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Business Name /Type: �� tOl 11 �1S —
Previous Business on this site 17 a l26
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
Qef, -"ti F�1fL L'�
vehicles, and any additional information that you can provide: 2 )10 yeel' ,
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1_ l�l�rl�j`nr UVS
*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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
cle-I
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 3 ( 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
Intake to complete the following:
Y1
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will 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 or blic ter?
If private well, provide Healt ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli Y
Is parcel on septic or ublic sew r?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ;90 /3 — .9 /-
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: '2 D SS
&IN
Permitted as:
Under Section: ge_l 4 y kci
Supplementary regulations section:
Parking formula:
Required spaces: n
YIN
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/6
If so, List:
Proffers:
&)IN
If so, List:
Variance:
YI(A
If so`List:
SP's:
Y /1O
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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