HomeMy WebLinkAboutCLE201200033 Legacy Document 2012-03-01Application for Zoning Clearance
CLE # WIZ-33
0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 10% Date: 'l
Receipt # 9>51,183 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 4 G.B a - I -- g Existing Zoning
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Parcel Owner: 1,40 l (V l�Le-act I ( - O � Ce- 1 (_ &-r, L (---
Parcel Address: L„52LA IK-S,*- ,race 14" City State V11V Zip 2)
(include suite or floor)
A . Jf't-i S. 1-.
PRIMARY CONTACT A I
Who should we call /write concerning this project?
Address • R L , ��X �� LL"7 City 0ACL,-la7C&5vi /re' State LM Zip
Office Phone: (V () TN - 9191 Cell # 90 -AJr99 Fax # IO E- mailSfgueO lTgrwrg La ,4� a" k c�
( - &-( 5e cell W LCV c, fvJ�cQ
APPLICANT INFORMATION
Change of name ✓ New business
Check any that apply: Change of ownership Changeyy of useqq
t
Business Name /Type: 6-CCn A°Jy cG L S7titiSc�,"�i txw� r L� Lc ��l �kcc � "ors ,oc- ,
Previous Business on this site T a eelI`e.7
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles any additional information that you can rovide: OR- -i�G i= k S I rkEE
V�v1iGlL°S L ^ ^iiE ��C " Al l� tr�� �� "►rCe✓' Ci vl�j �fJGCCt°S V'1 y�/ ic�E'rl
*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.
Signature rtr _ cY Printed S L L j Z)"i
APPROVAL INFORMATION
J 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 o n Date
Zoning Official Date Z,
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
ceit'k
Intake to complete the following:
Y /(S)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /NO
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
Circle the one that applies
Is parcel on private well o 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 public sewer?
Y /E1
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y / (S
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:
6) /N
Permitted as: 2,-,,T,
Under Section:
Supplementary regulations section:
Parking formula: /
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, ist:
Prof rs:
Y/
If so, ist:
Variance:
Y/(
If so, List:
SP's:
Y /1)
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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ect no:
12/20/11
1190
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