HomeMy WebLinkAboutCLE200800031 Legacy Document 2013-01-03Application for 66"j�
Zoning Clearance
OFFICE USE O Y
El Zoning Clearance = $35 CLE # 29 60-3
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # 6 Staff: yr_4
PARCEL INFORMATION
Tax Map and Parcel: 09000 -60 -06 ^- 6jhh7 � Existing Zoning � T
Parcel Owner• fig ,,,12, d /U0j , Rb P V ULc,•
Parcel Address:-/ 995 4PoA15rr6ie-_,wr_,0 City (Wejo7%iC,yz State yk Zip wo/
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 22A:&_�/e
Address: J(if! i�LO�Y (�� 41) City N,,0116&I— / ✓aKZc..State kZ Zip 'io?
Office Phone: ( Jr - cj 16 Cell � - iIIXFax # E -mail y0,/{ -)E[ LAE�,[> CC 111al }i 4 5,
APPLICANT INFORMATION
Business Name/Type: C -.LLJ6
Previous Business on this site "W
VV
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: A T-_ 15QRK DZA4/6 , ("
*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 � l Z. an
Printed 7 19;60 4
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
Date
Zoning Official Date
Other Official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
Intake �ttoco p lete the following:
-YES NO
Is❑ sue in LI,❑HI or PDIP zoning? If so, give applicant a Certified
Engineer's Repprt f�)lp%
�� Gil
❑ YES E��O
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 ❑ NO
Is parcel on private well or blic wa er?
If private well, provide L th eliartrnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or• ublic wer?
❑ YES ❑/O
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 #
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
1690
Supplement6 r1milations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector
Notes:
Date:
Zoning Tech to complete the following:
Violations: ` Proffers:
❑ YES ❑v NO ❑ YES ❑V NO
If so, List: If so, List:
Variance: SP'
❑ YES �NO M YES ❑ NO
If so, List: If so, List:
b r cad • f� fln�
J -1 2-V U 4 r
5/1/06 Page 3 of 3