HomeMy WebLinkAboutCLE200900217 Legacy Document 2013-01-03Application for Zoning Clearance
CLE# 2000 -'LDS
I&—
Zoning Clearance = $35
OFFICE USE ON Y 02 Y) S ��00 y
Check # `� 2- Date:
PLEAS REVIEW ALL 3 SHEETS
Receipt # NISI Staff: rf- t
PARCEL INFORMATION
Tax Map and Parcel: 0-& I U -01 • Q0- 01300 Existing Zoning C
Parcel Owner: :bji1 1 40r, L--A M t2 —MV .%-r . S. V F X. A L t -3IG I-Q (-k 1
Parcel Address: 2.11 1 IS S IS1.1 -41SA&A— it City CiM'i1rLM /lLld tate VA Zip 2.29' d
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? SUF- A. &1.- G!9.Ii Q N T—
Address : ��s pl'P.�� 1 CIA VLA C9: City CL-!AAWTi l �N114 tate A Zip Z
Office Phone: W 4,1 Cell #-531- 2 43: Fax # 2. E -mail Su 9.44 S2 Rx' i 6bi IfWyi OuS _ G
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 51 S1^19ca— AV r'0 Afki-S . J i4c.,
Previous Business on this site -5 7- A 1 -51 '-ZZ V A -t ft- CIE 1,11V IC ,
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: $"& lKW A,%"!p -U 15 -rrh 60—f a y o fs WIEW ,AVrD OLd °
�l WeLiffAL& ,P&i A d,"04 24tTAILo 5I) 1tf.nM0'1199AV.A -W
'7 e-omtrAuY d9 kte—L z(r
*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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signaturl Printed S Ur— A, A b-. t3 R,1e 6 H i'-
P OVAL 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 s'te plan as of-this to
Notes: ber W6
Building Official Date
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 04/28/08, 10/13/09 Page 2 of 3
M
Intake to complete the following:
Y/0
Is urn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will sere 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 ublic wat
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that Erpublic sewer?
Is parcel on septic
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. qj tg,, r oa- C- 2A&ATc t6 pN ar sib-4
Permit # a? CA 4.44 t, -Mr,—
DY,V N
t—ill there be any new constructio i or renovations?
If so, obtain the proper Pennit.'Y1gwolte4+s 91I.ul1N96 09
Permit # 6a1Kl51C -M A AV LA f0fV
r- IC&MAT TZ CoNiviror
Two 00:1":r 9b W J► CWM
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use:
m fitted as:
Under Section:
Supplementary regula io s section:
Parking formula: I J/ go Q+ ,G C S- I n S a
Required spaces: ( q
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violatio s:
Y /
If so, st:
Proffers: :
If st:
Var e:
Y/j
If so, t:
SP's:
Yi'I�
If , List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3