HomeMy WebLinkAboutCLE200800040 Legacy Document 2013-01-03Application for
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Zoning Clearance
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
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771
OFFICE USE ONLY
Zoning Clearance = $35
CLE # 266906M t�
Check # a d Date: -1$-D
PLEASE REVIEW ALL 3 SHEETS
Receipt # b Staff: VT--/,
PARCEL INFORMATION
0 C1X 2 - 00 - oO - 001 00 n I L 1
Tax Map and Parcel: Existing Zoning
Parcel Owner: F6,"e 5EAGVNS �PAQTw -ors L A.► -XTEZ �AQTIJS4MV4}%,P
Parcel Address: 6q �6w2 Sf ASa4s Nx�vE City C P,9,%-tlnQSJT -LkE State V R Zip z-Z5,0 t
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? -feE' i S rE;(,►,.q�,l �z�E PR.Es zDEUr� DEv�w oPs
Address : CIO MSS P.6, Box 53DC� City G�1R�w7sESJ; State VA Zip zP -905'
Office Phone: i( 3q) X53 -60GI OICell # 'J IA Fax # 41L "y4-261DE -mail t%t,{ 9
APPLICANT INFORMATION
Business Name /Type: /JO9T)4 (4)00DS Or -n4E R--a S EP 6dNS (`} k-eTk�Ts
Previous Business on this site S4r►�� A-� Ag6V E — rJo Gy�u(,
Describe the proposed business, including use, number of employees, number of shifts, available parking s aces and any
additional information that you can provide: 5)gA1V LAS /yo L L1raN
*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 g1'1beT D6604T Printed 1 a`4 STeL6+u4J /autt)nQr26D 4GE
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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, xl 19.
[ ] 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 r Date ;. tS I
/
Zoning Official Z4 G An 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
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771
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES ❑ 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 public water?
If private well, provide Health Department 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 #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 7 ecn to complete the tonowing:
Violations:
❑ YES ❑ NO
If so, List:
+t
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use: '7A 3 7
''YES ❑
Permitted as: a
Under Section: 3, 1
Supplementary regul�at/iq s section:
Parking formula: � p _ _a
Required spaces: ' G G r- (tit.(iL76 c�
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes
Proffers:
❑ YES ❑ NO
If so, List:.., ?
x Y
SP's:
❑ YES ❑ NO
If so, List:
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