HomeMy WebLinkAboutCLE200800012 Legacy Document 2013-01-03Application for
Zoning Clearance
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # a0c6e,6 0%,1
PLEASE REVIEW ALL 3 SHEETS Check # a3 .— Date:
Receipt # 3 Staff:
PARCEL INFORMATION
=Z
Tax Map and Parcel: C) 1Z d - d - 6 d " 0b A y Existing Zoning P c) .
Parcel Owner:
Parcel Address: \ Ac 0 _:5 1y City r �o es,;.«,State Zip 2Z 4 0'
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: ld 2a 4- City CL L X�- kkawbt 4tate V k, t ZipZ�t7
Office Phone: �) &15 -437J Cell # 5 3 1 -e S'7 9' Fax # E -mail q� \. a0et� tna \clam S
APPLICANT INFO ATIO
Business Name /Type: u r
Previous Business on this site 1 `-
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: 5,4 m 2.
*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 f my knowledge. a read the conditions of approval, and I understand them, and that I will abide by them.
1N
Signature '!� Printed \" \ W
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, x119.
[ ] 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
Zoning Official
Other Official
Date iT
Date
Date
County of Albemarle I)epartment of uommumty Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Cd ct 1.
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES XNO
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
WYES ❑ NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is parcel on septic or public sewer?
❑ YES XNO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # P, Zd o-7 d o a9
Reviewer to complete the following:
Square footage of Use: 4 � 4. 7`t
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector
Notes:
Date:
5/1/06 Page 3 of 3
z-
rjoning Tech to complete the following:
Violations:
❑ YES ❑ NO
Prof " s:
ES ❑ NO
If so, List:
If so, List:
SP's:
V"YES ❑ NO
Variance:
❑ YES ❑ NO
If so, List:
If so, List:
5/1/06 Page 3 of 3