HomeMy WebLinkAboutCLE201200074 Legacy Document 2012-04-30C. 6�
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
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Application for Zonin Clearance
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OFFICE USE ONLY
lb 2 Date:
PLEASE REVIEW ALL 3 SHEETS
Check # P
Receipt # j Staff: 6y' "I' V
PARCEL INFORMATIO
Parcel: %106 06' Existing Zoning f
Tax Map and
Parcel Owner: JG lV V4'0- /,T� L'4+
Parcel Address: (j�� //�(/� City State va, Zip 2 S
(include suite or floor)
-PRIMARY CONTACT
Who should we tail /write concerning this project? hA.nte Jc n4F_'.3
Address: 9,5 W00dl4r-ds i?caa.d CityyCharlalskesvVuG State VD. Zip 2.l-g01
43�
Office Phone: (42) Cell # 2s12._443e Fax # E- mail- Ye r� ►e St�l mC�o c�
APPLICANT INFORMATION
Check an), that apply: Change of ownership, Change of use Change of name New business
,Fa6r ,Food
Business Name /Type: L-uL 01no SUb3 f Sub Shoo
Previous Business on this site 04'Mae- - --
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: ,FQSr Food reSMUrand- 2— 4. ernPlo y.�mae� 7_
Currmklq C 0p oc - .Far -15
*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 Printed 54'29V-C n%e A - 30nc—S
PPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backilow 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 a detenninafion of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date L4 114 ti
Z//
Zoning Official ' "" Date
Zoning 2/
Other Official �% Date %IZ 2_101%
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
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Intake to complete the following:
Y/�
Is use nn LI, HI or PDIP zoiung? If so, give applicant a Certified
Engineer's Report (CER) packet.
'Y '/ N
AiII 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 epa ent form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ubIic sewer?
Y ' /.N
4K1 you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nnin6 fn rmmnlPfp fbp. followitt¢:
Reviewer to complete the-following:
Square footage of Use: 113-7-1
(Dl N f
Permitted as;
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
Y
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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