HomeMy WebLinkAboutCLE201400102 Legacy Document 2014-06-18Application for Zoning Clearance
CLE # jo — J O Z
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 1 O S a, Date: y
Receipt 'q
I Staff:
PARCEL INFORMATION # 5
Tax Map and Parcel: O"Z�E7b v 00 - 00 -- ,7 3 �� Existing Zoning
Parcel Owner: �1 t�c�+�� ��2P i -C' SS)C2J�Y� C C CN %Z"1C LLG—
Address-
(include-suite-or rioory-
PR-rN RY CONTACT
Who should we call/write'concerning this project?
Address: �2 i yc�.v h e o�d �Y�. City State
,ti
iV IY zip ,72q /(
Office Phone: ffi )'79-0 - / ?f Cell # �'0% J �' Fax # S� ^ �� /O E -mail C� j
�,LtO,3 Ul �Y'yiuiaL�KdCCrhtDany. Cen
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name
Business Name /Type: --gy-kLn yJ K!q cr.aj L �/�`�� � k; � j�55 t PLLC_-
Previous Business on this site_ VKc fkN j - LT—
New business
Describe the proposed business including use, number of employees, number of shift, a(ailable parking spaces, number of
vehicles, and a y additional information that you can provide: �I; k; �4( Ps y m
S - _ t_" 5 0Yt� S;k4F - tJar^.c( 2 tcc.'a << ),I,x- A. /.
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*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 accur e o the b st of my lm owledg�e.(I have read a condiiions of approval, and I un�d /erstand them, and that j will abide by them.
Signature
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
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 7/1/201I Tage .2 of
-f
Intake to complete the following:
Y /E)
Is use in LI, HI or PDJP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /LJ
Will there 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.
Is parcel on private well or6ublic water? j
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a I'
Is parcel on septic o ublic sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
�9 /N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # a014 ' _10,2e Ae
mooning to complete the following:
Vioi ons:
Y /&N
If so, List:
Vari ce:
Y/30
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use:
() / N nn
Permitted as: ��� d �`�rCsY
Under Section:
Supplementary regulations section:
,i alttaiib' 1V11LELi14.:.� � .
�� Z)
Required spaces:
Y/
Items o be verified in the field:
Inspector Date:
Notes:
roffers:
/N
If so, List:
Z ,,m
SP's:
Y /1`T
If so, List:
SDP's
Revised 7/1/2011 Page 3 of 3
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