HomeMy WebLinkAboutCLE201400066 Legacy Document 2014-07-25Application for Zoning Clearance
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 09 1 Date: 7
Receipt # 9 S' 22. Staff-
PARCEL INFORMATION
Tax Map and Parcel: �' �fh UL- Existing Zoning / v
.Parcel Owner: a 11V C.,bgTA u
Parcel Address: MI?i n U1an6' City 61W_L1' State Zip
(include suite or floor) -�-
PRIMARY CONTACT 'V 1. -To G IE�JTA
Who should we- call/write concerning_ this project ?_
Address: 11,75t) ) odd City �'�' State VA Zip
z 1 ci ti V 0To Cif T lmr. "e n-.
Office Phone: cfIll # Fax # E -mail
'f4 4e/r 6) Cox•, rU '
APPLICANT INFORMATION C � CaIMC 4� -
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: —� ' I •42XkA+– 'ft' -)14 1
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, a ail le ar 'ng spaces, number of
vehicles, and any additional information that you can provide:
*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 ac ur e 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 1 Printed I I (0 ��k
APPROVAL INFORMATION Denied
Approved as proposed [ ]Approved with conditions [ ]
[ ] Appro e prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] erefore, it is not a determination of compliance with the existing
No physical site inspection has been done for this clearance. Th
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 7/1/2011 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 /
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
Reviewer to complete the following:
Square footage of Use:
PeZtted as: 66,U
Section:
Circle the one that applies Parking formula: (l,l (@ n`r �
Is parcel on private well or public water? _ tx
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAXDATE-
Circle the one that applies
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit#
V/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # j'L--9Mf T VJ A-S
&IL4,- 0�3at6l-'TM40D-
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Zoning to complete the following:
Viol s:
Y /�
If so, List:
ffers:
Y N
so, List:
Varia ce:
Y/
If so, Lis :
SP' s:
Y
If PN t:
Clearances: r2
SDP's rr��
Revised 7/1/2011 Page 3 of 3