HomeMy WebLinkAboutCLE200900008 Legacy Document 2009-02-04Application for Zoning Clearance
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Fi!oning Clearance = $35
OFFICE USE ONLY
Check # 113-3 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION /
Tax Map and Parcel: 1 Existing Zoning
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Parcel Owner: I.�IZ4&41 w� 06f4 / ILf.✓'7
Parcel Address: 2 IIDT 7`4,_�Jz cr. AWcity o State 114 Zip2,-Fv/
(includes ite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: AE�41�v L,,✓ City Statez! / Zip
Office Phone:! Cell # 2 Fax # V-y1f E -mail GAr!/ZL
e,-V&'IG /
APPLICANT INFORMATION
Check any that apply: han a of ownership _ C ange of use Change of name New business
Business Name /Type: .0
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Previous Business on this siiet
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information tyou-can _ p� de: /Q.,,,l�v,..0�� G�,l,,����5
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*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 t e best of my k d . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 4�wille—
AP 'ROVAL INFORMATION
[V] Approved as proposed [ ] Approved with conditions [ ] Denied / /
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. - -�%hJ4 /
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a detei-rnination of compliance with the existing
site plan.
[ This site complies with the site plan as of this date.
Notes: p,.�
Building Official Date Z
Zoning Official AAA& 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 04/28/08 Page 2 of 3
,s
Intake to complete the following:
Is / L tf
Is US ELI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
are Will 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 —tc w, ter?
If private well, provide Healt rtment 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 b�i� r?
Reviewer to complete the following:
Square footage of Use: �(r7
AN
Permitted as: ��&-ax
Under Section: • (w)
Supplementary regu ations section:
Parking form a
11 67A�
Required spaces:
Y / N �TLG�X
Items to be verified in the field:
Y/N
Will you be putt ng up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector: Date:
Y / N Notes:
Will there be ai y new construction or renovations?
If so, obtain th proper Permit.
Permit #
ZoninLy to complete the following:
Viola ons:
Y/
If so, ist:
Pro rs:
Y
If so, List:
Variance:
Y/
If so, st:
SP's:
Y /6Z
Ifs , ist:
Clearances:
SDP'
Lon •
S a4fa rO Oef- d 0-05
Gi d d
Revised 04/28/08 Page 3 of 3