HomeMy WebLinkAboutCLE201200034 Legacy Document 2012-02-16Application for Zoning Clearance
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CLE #-20 12 -,-34
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # M90 Date: G - IG -12,
Receipt # Staff:
PARCEL INFORMATION
LA 002 e D
Tax Map and Parcel: % Ea-1 - Existing Zoning Pl'.0
Parcel Owner: lV v l y f Lt �� Pry , �u��f LL(-
Parcel Address: TKS+ -LV-C tce.L. C) jtCity � �(Cffi 5O State V/q zip "9�/
(include suite or floor) (J 1 C
PRIMARY CONTACT
Who should we call /write concerning this project? eo d ri
Address : I "• e-p7, (K147 City elarlr�lf�vl �l jj1le State Zip 225—c-14
Office Phone: OY, ) 979- 257e/ Cell # 906--,UM Fax # �5n� E -mail Sf�ueC�lVrrni r�;�tc�t�eo�+ti�a�
El e e,. 5,& r �� 1 f c7��k C` •T eJPC�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: L�Cy d i 5 '\) � 5 t -c,( 'G i 111 c7vl,S
Previous Business on this site if A CT
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: O F -1 G L Coe,
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5 17 Gin Cc,�ES 2,0 Cdr- %wC SPrtGeS �ro�ic��c
*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 accur e to e b st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �• � Printed S,
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 h -I 0,1
Zoning Official Date 2 z/ 3/ �l
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
y'. e- --V *
Intake to complete the following:
Y /6T
Is use in LI, HI or PDIP zoning? If so,. give applicant a Certified
Engineer's Report (CER) packet.
Y/®
Will there be food preparation?
If so, give applicant a Health Department forma
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 water
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 applies
Is parcel on septic or r blic sewe
Y /O1
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /iQ
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: 1
, / N n n�
Permitted as:
' -I R �,1-�1
� I
Under Section: '2 o
Supplementary regulations section:
Parking formula:
Required spaces: Y
Y /tN
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/&
If so, List:
Proffe s:
Y /N
If so, List:
Variance:
Y/
If so, ist:
SP's:
Y
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3