HomeMy WebLinkAboutCLE201400209 Legacy Document 2014-10-31Application for Zonin Clearance��
CLE # 9 ( 14 -
OFFICE US Y Im✓,Z� (/'
� N Date: `V 4
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # r 5 i Staff: rnkfv,�
PARCEL INFORMATION p y�
Tax Map and Parcel: o b I -z O O 3 - oo "- ,2 D,s It} 0 Existing Zoning T an OrJ
Parcel Owner:
Parcel Address: O ) /1j (Oor. 7l-e City ala r to -pe-L II9ptate VP's Zip22-76 1
(include suite or floor)
PRIMARY CONTACT j
T01\,4
Who should we call /write concerning this project? V a
Address : fi 37 L/J "S 1,e14j 4C City 25i11 �ip State Y A —zip 22-'9c)(
Office Phone: Cell # - 0L/0Fax # E -mail 'onc,�iCi�� �Gc �a 4
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: i'P,�M 1� 1' 2 S 11,�.' .- �a A 7�l i0 iCiPi
Previous Business on this site 1l ` w� & A p j �b_
Describe the proposed business including use, number of employees, number of shifts, available parking Maces, number of
L 1 Vo §- 6 � C'_
vehicles, and any additional information that you can provide: �, A S M D .
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r�.r• plv�ees
*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 urate to the best of my knowledge. I have read the conditions of approval, and I understand them, I will abide by them.
`and that
Printed arAtib.AS1
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 (-Z
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
i+ i'
Intake to complete the following:
Y /6
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
K1
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
Circle the one that applies
Is parcel on private well or � er?
If private well, provide Healent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or p blic s er.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: AJ l
CY / N C) 40 ( L
Permitted as: �f'
Under Section: 10. �/-
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y/&)
If so, List:
P offers:
(D/N
If so, List:
Vari ce:
'
Y/ , '
If so, List:
SP's:
Y /hT
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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