HomeMy WebLinkAboutCLE200800034 Legacy Document 2013-01-03Application for
Zoning Clearance
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # a 60S b 6 p 3A
PLEASE REVIEW ALL 3 SHEETS
Check id 55 3 Date: o
Receipt # 6 q % -5 Staff: V —1
PARCEL INFORMATION CO-
_ a 300 P O C
Tax Map and Parcel: Ob 100- 00-00 Existing Zoning V
Parcel Owner:l io p ei s Limited Pactnersh,' Q
Parcel Address:61 b AI bemae le Sou" city lb VI State y K ZiP3
(include suite or floor)
PRIMARY CONTACT �friET W.
Who should we call/write concerning this project?
' City fAddress : li%I a State Zip
Office Phone: �{� ••!� l Cell #60 • 16C Fax # E-maiLJJ&wd OP AAA MkD C,
APPLICANTINF0RMAAO- Wan +;C. AutDTrarel, wel /Ins. ]Financial SVGS.
QQ
Business Name /Type: ,,gg��
j�1�
1F &r a
Previous Business on this site +
4
Describe the proposed business, including use, number o employees, number of s s, available parking spaces nd any
additional information t you can rovide: i ve i h& 41al
+0 ,
m
*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 ac ate to the best of`mmowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed�E� W •R�'W
Signature W
APPROVA 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 �-T
Zoning Official Date
Other Official Date
County of Albemarle Department of Lommumry ueveiopmenL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to complete the following:
[:]YES d NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES X 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 ❑ NO
Is parcel on private well or p lic water?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or bl c sewer?
YES ❑ NO
ill 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, ob n the pro�lr Papnit.'
Permit n% o�l1V
ZoninLy Tech to complete the following:
Reviewer to complete the following:
Squa,6 footage of Use:
7YES ❑ NQ.
`
Permitted as: 0 !4A A-6 C(
Under Section: �� + J a—
Supplementary regulati gns section:
+OI
Parking forniul�
Required spaces_
❑ YES ❑ NO 1
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
❑ YES ❑ NO
If so, List: /
Proffers:
El YES
If so, List:
i NO
i
Variance:
❑ YES NO
If so, List: ❑
SP's:
El YES
If so, List:
i
5/1/06 Page 3 of 3