HomeMy WebLinkAboutCLE201200037 Legacy Document 2012-04-12Application for Zoning Clearance
CLE #
OFFICE U NLY
PLEASE REVIEW ALL 3 SHEETS
02--c" Date: _I
Receipt # Staff:
-
PARCEL INFORMA
Tax Map and Parcel: Q G�1�� �'�!( %„ r�Li� Existing Zoning Pub
Parcel Owner: �AT
Parcel Address:. 01 J c 2 k ! City. ft'�'t State Zip
�-1 - a
,11
(include suite or floor)
PRIMARY CONTACT .,
Who_should we caW_write_concerning this project?
yf� _�fin/ COW- ks-�
Address: G .4e Zwa 2- V1 City V1 Tie, State V Zip, �
Office Pbone 3- Cell' # '3-? ^ 7 ax # E -mail
1XJ
APPLICANT INFORMATION
Check any that apply: Change of ownershi(p� Change of use Change of name V New business
Business Name /Type: IZ V1 t (\c, �✓ ��-1
Previous Business on this site
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:
*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 ,r Printed A–) 7144 G'i-
APY,ffOVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 - 4511, x117.
[ o 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 / Z
Zoning Official Date �1 a
Other Official Date
County of Albemarle Department of Community 1Deveiopment
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,9
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wi ere 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: 1 I 1
Y N
ermitted as:
Under Section: ' IVQ QOJW ^
Supplementary regulations section:
Circle the one that applies ParxinR rormuia: , " �aOO �� k� (� - ut� -
Is parcel on private well ublic ate ? ( �u
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 applies
Is parcel on septic ubhc sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Y/N
Items to be verified in the field:
If so, obtain proper
Y /0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nning fn rmmn1PfP fhP fnlinwino'
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
offers:
(z //N
so, List:
COYYI�PYGi'� CSR �PKW�
Variance:
Y/N
If so, List:
LY)/N
If so, List:
Clearances:
ao� - ao
SDP's
Revised 7/1/2011 Page 3 of 3
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