HomeMy WebLinkAboutCLE201000246 Legacy Document 2012-04-113
f
rt �
_>
Application for Zoom Clearance
CLE # Q L
r
y .
k •l J•
Zoning C[earanec =$35 Citeck # r Date: i�
PLEA REVIEW ALL 3 SIMETS Receipt # / Staff: A&
-PA c TNTOR€� ° -ION-
Tax Map and Parcel: Z o i (D Z D - S f- G Existing Zoning
Parcel O►vner: Yha___ n�nwt•r�-�t W Y��l� f}
Parcel Address: Ecrl 5y --em City Zip
(include suite or floor)
PRIMARY CONTACT tt tt
Wt ►o should ►ve ca[Vivrite concerning this prof ect? - V ICJ E kA e �_ l) r ltd
Address: � � NarL y r) �Y—A City State L'/ l Zip
Office Pl►one: 3 7���i � ell # ',b�2.-Fax # Email
f
. APPLICANT INFORMATION
i Check any that apply: Change of ownership t j Change of use tCChange of name t- New business
Business name /Type: V t� 6 `C, C-\ 1 t
Previous Business on this site 250e S 1 Z�7--
Describe the proposed business Including use, number of employees, number of fhifts, available parking spaces, number of
vehicles, and any additional Information that you can provide: YZ <S(4V�t`G.yt �' Ct>` ►�t�O t�� ras L� nt~�i
*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 ar have the ►e s ermission to use the space indicated on this application. I also certify that tl►e information provided
is true and accur to to the best of m knowle e, I have read the conditions of approval, and I understand them, and that I will abide by tlteni.
Signatur printed W r�ua�
APPROVAL INFORMATION
[ ] Approved as proposed [ ) Approved with conditions [ ) Denied
[ ;) Bacictlow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4511, xl 17.
[ ,) No physical site inspection has been done for this clearance. Therefore, it is not detenninstion of compliance with tire. existing
site plan.
[ ') This site complies witli the site pfan as of this date,
Notes:
Building Official Date ( l 41 ( o
Zoning Official Date 1�y1/1
Other Official % Dated
y.
C:4n11 of Albemarle uepartment of c:ommuruty uevetopment
401 AlcIntire Road Charlottesville, VA22902 Voice. (434) 296 -5832 Fax: (434) 972 -4126 -
Revised 04/28/08, 10/13/09 Page 2 of 3
Intake to complete the following: - Reviewer -to complete the following:
-. Y / Square footage of Use: 90-0
Is us ", LI, HI or PDIP zoning? If so, give applicant a Certified j
Engineer's Report (CER) packet. (D/ N
- - -- - - - - - -- --------- - - - - -- - _ - - - - -- - -- _ ___ - - -- - -- _-Permitted as: - -..._- � --
Y/N '
_ il there be food preparation? Under Section:
i
1f so, give- applicant= a-Health= Department - form. --
-- - - Zoning�eview can not -begin imtil-wereceive- approval from Health - - Supplementary- regulations section: - - - — - - - -- -
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o(,-) ubli
c water
If private well, provide Healt i epartment form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle th applies
Is part l on septi or public sewer?
r/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will t sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
� - - - -- - -1—. — J.L.- C-11.,..,. --
Parking formula: f
Required spaces: '
Y/
Iten�<to be verified in the field:
Inspector:
Notes:
Date:
ZLV Ulu" w a.vaaa
Violations:
Y /
If s , 1st:
Proffers:
Y /�N
If so, List:
Vari ce:
Y/
If so, List:
SP's:
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
Q
Q n
T
�r
1