HomeMy WebLinkAboutCLE201200070 Legacy Document 2012-04-04i� Fed EK
Application for Zoning ClearanceW_
pF Al.lJj.!11
CLE # 2b 2.
OFFICE USE ONLY
211 4 -2 - I Z
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: \ V
PARCEL INFORMATION °" �•
Tax Map and Parcel: 06000-00-00- 048 q O Existing Zoning e 2
Parcel Owner: Ll►c-
Parcel Address: ?-LALO 6 \ci a-��l +�.S� City CSr e� <iet%eSJ�2- State Zip ?23
(include suite or floor)
PRIMARY CONTACT
�dv+ti��n�SCt�lL0`C o.�
Who should we call /write concerning this project? \ C.Vy% v-,u
�Ax.�1 3G�rv�scv1 a-v�c •
t� ``__
Address: k155 4!Rx �� City (yQa,�`1o��F State TQV '( Zip \OGX -L
Office Phone: 3M-\-S9\ Cell #(. A6-2,66- ax # L \2;- S66-951 b E -mail �-a .�(t �clC a�ax��'uahv�sor�• ca�M
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name A New business
Business Name /Type:
Previous Business on this site NOVXA-
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: ".¢.�Qjx t �,wrS 5 or rtio
*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
and accurate
Signature A ^.� -� Printed \ ey.�nnvv�c7�v� a � • `c�a`�C`c � UL
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:
'�— Date 'L4 t
Building Official
r
� Date
Zoning Official
Other Official Date
County of AiDemarle MeparL111CUL vi l UJJJJJ1UA ,y yam.., ,t. =... •..
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 or� lic wa Y
If private well, provide Health -Departmd'nt 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 p/ lie sew 9
s
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following: `�
Square footage of Use: l 9
�/N
Permitted as: 6 ; :- ; `;
Under Section: ^ •f2^-
Supplementary regulations section:
Parking formula:
Required spaces:
Y / `
Items to be verified in the field:
Inspector :
Notes:
Date:
/,onmg LO COm tee ruC iuuwviu
VioM,ii 'ns:
If s st:
Proffers:
/N
f so, List:
Vari ce:
Y/
If so,�ist:
Y
If so, List:
Clearances:
SDP's y
Revised 7/1/2011 Page 3 of 3