HomeMy WebLinkAboutCLE200800036 Legacy Document 2013-01-03Application for
Zoning Clearance :�Af�
OFFICE USE ONLY
oning Clearance = $35 CLE # Z009- 3
PLEASE REVIEW ALL 3 SHEETS Check# J Date:
Receipt # 69o7 g 111�_ Staff:
PARCEL INFORMATION
Tax Map and Parcel: / Existing Zoning P9_
Parcel Owner:
Parcel Address: I I ® C W,av Le, ��,���rC City L( v(' � v State V JN Zip 11,2931
(include suite or floor)-
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: 3X0$ A-05 6_w°d 19 t,,A-IJ6
DAv 19 2 J 0 &J a5
city
State V1611
Zip �� 5 a3
Office Phone: i('3`() 'L`(3 - &4g3Cell# 25� '�Sty�Fax# E -mail of�o"AS llt ✓`jY,ta'�a
APPLICANT INFORMATION
Business Name/Type: (-"v e 6e-14 C Ll:lIrv6`r -S
Previous Business on this site t, 7-14-'l f { 0 ` C Z,lc�icS
Describe the proposed business, including use, number of employees, number of shifts, available parkin spaces and any
additional informatioq that you can provide: 6-1
*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 tA the best of �ny ki ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �I(� Printed'
APPROVAL INFORMATION
[ proved as proposed [ ] Approved with conditions ISe ii d ow Device anG
B.ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -451 , -119'-rent Vest Data Ne
[4/jlNo physical site inspection has been done for this clearance. Therefore, it is not a determination f 66 npliocAlegll) t" 4i j,
site plan. _._....., _- .. _.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date l l o
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 3
119
Intake to complete the following:
❑ YES X10
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 9-<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 public w ��?.
If private well, provide Health DI epartment 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 ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # &J 0
❑ YES �J` NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
GonM I ecl► to complete the
7 .
� YES L4 •
If so, List:
'
Variance:
r_] YES NO
If so, List:
Reviewer to complete the following:
Square footage of Use: A
VyES ❑ O
Permitted as:
Under Section: �•� �� W
Supplementary regullalio s section:
Parking formula:5��1 r
Required spaces: `/ J
❑ YES ❑ NO V
Items to be verified in the field:
Inspector :
Notes:
Date:
5/1/06 Page 3 of 3