HomeMy WebLinkAboutCLE200800027 Legacy Document 2013-01-03log
Application for
Zoning Clearance
_ OFFICE USE ONLY '
Zoning Clearance = $35 CLE # ���
PLEASE REVIEW ALL 3 SHEETS Cheek # Date: 2
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 —7 ! 0o O(J 00-I 0 ® Existing Zoning R A
Parcel Owner: R ei/� Go I CA S -f-p- b'Yl
Parcel Address: (pH 1- btCk-L4,1God5 fatl._ City(,'Vi J&
(include suite or floor)
State V Iq
PRIMARY CONTACT
Who should we call /write concerning this project?
Address :
City
State
Office Phone: (j ��) � V?OV Cell # Fax # E -mail
W641 I
APPLICANT INFORMATION
Business Name /Type: Np6y6h . %�i� 0c'e'- &-Lc to
Previous Business on this
Zips /03
Zip
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: W I)a & 9 �- st- hAeLIE ZA U cz (z* 2-0 d,_,z0J
*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 pennission 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
APPROVAL INFORMATION
[ ] Approved as proposed [ roved 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
sit xf. ' --� Y, a,: his site complies with the site pl n as f till date. yr��l-�� 3v tes: /i�% - / �i n OK S S p GtQ V� (�
i` s &I r 0— —d- f,
t----
Building Official Date -1_I
Zoning Official Date 6g
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
/ ry
Intake to complete the following: I/ VU 7— � 5
YES F-1 NO SP 67
I in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES ❑ NO
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
❑ YES 05 • Q�
Is parcel o ivate wej-r public water? 0" S
If private �I•.,prwi -de H �itli Department fort
Zoning review can not egln nti-I-we- receive approval from Health
Dept. FAX DATE 0$
❑ YES ❑ NO
Is parcel !Ke r public sewer.
❑ YES N NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 5 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninL Tech to complete the following:
Reviewer to complete the following:
Square footage of Use: d 0
[YES ❑ N // /�, r
Permitted as: d u A( d 10 5 � ` ° (L( :
Under Section:
Supplementary regulations section. I
Parking formula: 6 h 10
Required spaces: 1 -I-� I _ i
YES F] NO ( l V
Items to be verified in the field:
-�_
Inspector : Date:
Notes:
Violations:
❑ NO YES
If so, List:
Proffers:
❑ YES
If so, List:
WO
Variance:
❑ YES NO
If so, List:
ES
yso, is
❑ NO
.b
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