HomeMy WebLinkAboutCLE200900210 Legacy Document 2014-09-09Application for Zoning Clearance
CLE #
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IZoning Clearance = $35
OFFICE USE ONLY
Check # 5 j Y,;,' Date:
PLE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
�T' 0 b i — G t.A,L-
Tax Map and Parcel: d7 !7b -` D --�) D -i Existing Zoning o M M GAL
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Parcel Owner: 91V M kv2tE2� ✓1/t/
Parcel Address:'? [S W (NECK&- iVML,4 S-M7,01 City (hM/ LVT- VUP State
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project ?[ C� tit
Address : MDi N(T klyu= (A �' ��I Ci" (L(,b"[ State UA Zip _
Office Phone: 1'� Cell # Fax E -maiI G67 ,�oVTULANn ke5lW,,
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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:
*This Clearance will only a 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 w' required
I here( rtify that I wn r ha a the ner' pe i lion pace indicated on this application. I also certify that the information provided
is true ccurate to he b st o my le e. I e read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ����b 0� TVR �MN
APPROVAL IN ORMATION
Approved as pr osed [ ] 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 r Date
/.
Zoning Official Date 9' 2w
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. 04 /28/08, 10/13/09 Page 2 of 3
Intake to complete the following:
Y /6
Is use in LI, HI or PD1P zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /nN
Wiikhere 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 Eli ater?
If private well, provide He 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 ewer?
Y/N
Will you be putting u rrleiw-
sign of any kind? If so, obtain proper
Sign permit. Vi�ii,,
Permit # O+ r4V J✓vG-
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit
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Zoning to comnlete the following:
Reviewer to complete the following:
Square footage of Use:
2n�tted " �� as: 2 � it d &Wt Ge,
Under Section:.
Supplementary regulations section:
h- a
Parking formula: `/ 0
Required spa es:
vle,6
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/6
If so, List:
Proffers:
N
If s014jst:
Variance:
Y /,�jI'
If so, ist:
SP's:
�Y /N'
If so, Lis
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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