HomeMy WebLinkAboutCLE201400228 Legacy Document 2014-12-04Application for Zoning Clearance
CLE# 20H "ZZ
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: + Existing Zoning Z? q
Parcel Owner: LV,,,zE -r
Parcel Address: SP 3 I!* 6-ttL'b Ir b City P , State d7 `ly Zip
(include suite or floor)
PRIMARY CONTACT L
Who should we�caall /write concerning this project!? /� � L
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Address: ),5 -7 6 (S/ t ad (4 R f ak MValiCity ��V(t�{�� D 19 &w fkstate V � Zip
Office Phone: 1f)j) q � -bjt Cell # Fax # E -mail SCO-H. I rj 4 Q-S1 V,SCO1JJ1 /1C'
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
j�Change
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Business Name /Type: rr Sc uls a� �ii'►7gr c o l V y t
Previous Business on this site
Describe the proposed business including use, number of employ_egs, number of shifts, available parking spaces, number of
n
vehicles, and an additional informati that you can provide: C AZ)E-CAOy ,
*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 f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature - Printed Sr —CT 6
APPROVAL INFORMATION
$41 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 (( I(-(
Zoning Official Date
Other Official Date ZL 2 -/Z-6A1
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
A
Intake to complete the following:
Y /0I
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / (TQ)
Will t 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 wel r-ptib is w ter?
If private well, provide ealth. -D artment 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 u lic sewe
CYO/ 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: Za d 0
01 N %
Permitted as:�Del/
Under Section: A,r(!!M • pYP,C'+i C.L
Supplementary regulations section:
Parking formula: ---f'"
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y / �I
If so, List:
Proffers:
Y /
If so, ist:
Vari ce:
Y /NN
If so, List:
SP's:
O/N
If so, List:
67
6 63J
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3