HomeMy WebLinkAboutCLE200800037 Legacy Document 2013-01-03Application for
Zoning Clearance
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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
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OFFICE USE ONLY
CLE # () 0 5? .�
oning Clearance = $35
Check # 3 5'9 5 Date: ' — 1 [l Sr
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION
Tax Map and Parcel: 2a 137/`� Existing Zoning:
Parcel Owner: Lar �t MVS 116� k,4 4
Parcel Address: ( � � /�fl �� � r0 City i _i-�o4 ,pv k State V N Zip Lq J1
(include suite or floor) Se CDrf
PRIMARY CONTACTr�S
Who should we call /writee^concerning this project?
Address : 2139 (f'4 1-01 City 'P6 011 ,toL%1 State Zip .7-50
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Office Phone: &b M-Z23e Cell 814-( q;RFax # E -mail 1 `f ��Z� �M&t• -f.
APPLICANT INFORMATION / ,
EZA F& 41
Business Name /Type: O_L_ r ve S — P S S e i i
Previous Business on this site I l-f �
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional infor ation that you can provide: (��P %`/e �,s �° 1✓CI i %/� /� ra
*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 w4LN d.
I hereby cern r have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and a best of my k, ledge. I have read the conditions of approval, and understand them, and that Iwill abide by them.
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Signature Printed -- -�-+'1 i. IN Q
APPPPPPP�OO TION
[ A ,pproved as proposed [ ] Approved with conditions a��]: 11'i`eidDevjcc �njl /mr
[acicflow prevention device and /or current test data needed for this site. Contact ACSA, 97 451`jrylelt9,;, Test. �, +1 j�teetcll
[V] No physical site inspection has been done for this clearance. Therefore, it is not a deterrninafion, of,. compllance�witl lltliF::c,�islhigI r
site plan.
[ ] This sit con lie wit the i e lan as o" this dai�����
Notes:
Building Official r Date
Zoning Official Date 6
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
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Intake to com a the following:
❑YES NO
Is use in LI, HI eNO oning? If so, give applicant a Certified
Engineer's Reppacket.
❑ YES
Will there be fo od 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:water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DAVE
❑ YES �0
Is parcel on septic or public sewer?
❑ YES
Will you be putting up a new sign of any Idnd? If so, obtain proper
Sign permit.
Permit #
❑ YES 0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
GonmLy Tech to complete the
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES iNO
If so, List:
Reviewer to complete the following:
Square footage of Use:
1100
YES ❑ VO��+�
Permitted as: ��Iho�L�1Ci
Under Section:
S Lipp] ementary r g rations section:
Parking form 111;Z6, z5 e f r n
v
Required spaces: -L
� G
❑ YE NO
Items to be verified in the field:
Inspector : Date:
Notes:
Pro hers:
YES ❑ NO
Ifs List:
w
SP's:
❑ YES ❑ NO
If so, List:
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