HomeMy WebLinkAboutCLE201400227 Legacy Document 2014-12-04Application for Zoning Clearance�.'`'�
CLE# ZDty'ZZ_:T
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # Staff:
PARCEL INFORMATION //� _. // (0 ,
C, Tax Map and Parcel: C) `7 ` Existing Zoning
Parcel Owner: B p, of Ll' y n d Cy Yl fo r
Parcel Address: 2-0-70 cSem 1 Flo City 1k State VIA— Zip 2_2 ?0
(include suite or floor)
PRIMARY CONTACT /
Who should we call /write concerning this project? C L an Wj
Address : l dq i) Shady fi f Q k J Ai y City C iQ ( W f7tsy ) tP State V h' ZipZ246
Office Phone: &iq) Fax # E -mail T1&.7 i jQ n (9�q 1f<0 U �d
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of u s e of name New business
�Change
Business Name /Type: ` S Q j c& j se" L ` Lw�k v1- a n i?cce
Previous Business on this site
Describe the proposed business including use, number of employee , number of shifts, available parking s�pa�je_s, number of
vehicles, and a additional inforr►kation that you can provide: !k\ c�S�NtAS � Sim A x°114 -��
M�c ik
*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 �_T rgtJC
APPROVAL INFORMATIO
>] 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 Date1u6�2o %�I
Other Official Date
County of Albemarle Department of Uommuntty 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/
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will bwere 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 ublic wa r?
If private well, provide Hea� ment 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 p c sewe .
/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 followin :
Reviewer to complete the following:
Square footage of Use:
Za J0
(VIN f
Permitted as: LC&
Under Section: 4AM, V ,r ;G
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /9?
If so, List:
Prof s:
Y/
If so, List:
Variance:
Y /6)
If so, List:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3