HomeMy WebLinkAboutCLE200800032 Legacy Document 2013-01-03Application for
Zoning Clearance
Al
,t
tr'!ln ^trtt F
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # :Q 66QD66_; 2
PLEASE REVIEW ALL 3 SHEETS
Check # 266d Date:
Receipt # Staff: d>T5
PARCEL INFORMATION
Tax Map and Parcel: "✓Mp orr /�AiQc L S SSA -/; �S��d� fisting Zoning ,/ WA VI
Parcel Owner: QG�5 ?R+�► /L �G� ('LU�3
Parcel Address: 5_S4?V A7645 CkQk City CRO Z r1' State r�/A Zip o�oZ93z
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? I-fRVG'ff' '-' , (!5:44vo-71-1
Address: Rog 06 vZ9L ✓1e2-1 57. City e'yA�/24077*5'19��State i/19 Zip
Office Phone: (e.6 V-'143 % Cell # Fax #TAT-2Z51VV /%E -mail
Nom: CoAlmer ,9 r pGC� 7R,4i& /5 SErt+ vr9i✓ N,oGL — y3'9 - s' 3/` g7#f (
APPLICANT INFORMATION
Business Name/Type: GROUT' /S"7 if (3)
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: ;2 # 7y 4NN4i94 5-,A- V41- e"71Aae CaUAES 44-C , 4
>rUNa 7Qi9%Sl/lJ6 %�20,T#'tJ�l�'D.t7 .G /f.GdW75 �iQGY4/yJ1A% /O�/— Ald -;rt 11Ve.
!✓ /lL y3F SDGa 47 7WIS FvC v7- —A,77Z z 5 F.f 4;7NCAIA2�
*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 luiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature C Printed -'�:"f[JF Cr44wle71
APPROVAL INFORMATION
[ ] Approved as proposed [ p]-iVp"p*roved with conditions [ ] Denied
_[ ]_Baslcftow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
,L,] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] Thig'�sit compli�j/s/with the s'te plan a of tl is date. (r`
Notes: i )) lJZil /-tf IN .0 i2'd>
n 6
Building Official �- Date, Z (�
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
511106 Page 2 of
Intake to complete the following:
❑ YES ONO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES 0,,NO
Will there b ood 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, bli water?
If private well, provide Heath epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septi • or eer?
❑ YES 1O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES I / NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1'ech to complete the
Violations:
❑ YES ❑ NO
If so, List:
r'
u� V
-v
Variance:
❑ YES ❑ NO
If so, List:
r
\I
Reviewer to complete the following:
Square footage of Use:
[YES NO
Permitted as:
Under Section: �Y
' V
Supplementary regula�ions section:
h I
I
Parking formula: r WA
1 1
Required spaces:
❑ YES ❑ NO
Items to be verified n the field:
�I
Inspector : Date:
N tes: r _ I n it
D /YV'L�/N y Nt(W�lD —f-1
ire ,Gtr_ ' e,(► t7 5 ` �� e C�� 4(—. ,c,�'�� -�F
. i IA [�—( yU:'
Proffers:
❑YES El No
If so, List:
A i I/v
V " \Y
SP's:
❑YES [I NO
If so, List:
I .
I
1
11 v 1 1
V
511106 Page 3 of 3