HomeMy WebLinkAboutCLE201200048 Legacy Document 2012-03-01Appiicaf. ®.n for .Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# Date:
Receipt # Staff: 1
PARCEL INFORMATION
�✓
Tax Map and Parcel: Q y500 -. 0 Z - 0 0 - 00 q00 Existing Zoning ��
Parcel Owner: 1lO-'✓ war 6, de 1411neS_
Parcel Address: SGMIA;DCir %f?y -/L City cbarlQlfesvz State 'V4 -zip2Z�fr7
(include suite or floor)
PRIMARY CONTACT lr
Who should we call/write concerning this project? C QLS 1Ti N "N dC5 �;� L'I,i X �0. ���
Address: %S21 Le irki hd if 7-&('/ City ClI dt—lLi Ae vI ZI State Vq Zip ZZC?O/
Office Phone: (LL3�) 2113-9,TZ9 Cell# k.3Y2'93267 Fax# E- mail Xl' vbdlire @yarlay_to,n
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: l R 16-1114(\J A BLOW
Previous Business on this site —& e/ �a /0 r'1
Describe the proposed business including use, number of employees, number of��s�pifts, avajlable .parki g spaces, number of
79n�
vehicles, and any additional information that you can provide: �Cm'r C'u7�S ,f/Q� (a orihq an E•�.�� V "e
*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.
l hereby certify that I own or'have the owner's permission to use the space indicated on finis application. I also certify that the Information provided
is true and accurate to the best of my knowledge. I h ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature �ir�Q Printed ( "R1,5 T141V IWAI &IVIYAJ
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ J 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 Of Y 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 7C1 /204'1 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP.zoning?
Engineer's Report (CER) packet.
I:f so, give applicant a Certified
Y/(9N
Will there 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
.Reviewer to complete the following:
Square footage of Use: p5'
Permitted as: &sl y �A f! o r,
Under .Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well or ublic water? a U 5
If private well, provide Heal Department form,
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o public sewer?
Y/N
Will you be putting up a new sign of any land?
Sign permit.
Permit #
Y I
Ite be verified in the field:
If so; obtain proper
Inspector • Date:
Y / (� Notes:
Will�trt" )ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Z,onino to complete the following:
— _iolations:
/N
so, List:
Proii rs:
Y /CN
If w, List:
Varia ce:
Y/IN
If so, ist:
SP's•
Y/1
If so, Est:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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