HomeMy WebLinkAboutCLE200800042 Legacy Document 2013-01-03mo�ta gm-5-10'g
Application for
Zoning Clearance
-t= _
❑ Zoning Clearance = $35
OFFICE USE ONLY t�
CLE # ;d 6 fe06 1
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Ot /06 T d d "6 b ^ d � J `' Existing Zoning �J'f
Tax Map and Parcel:
Parcel Owner: 6Fe-'(�-
pp� �<<�� /�
Parcel Address: �Q u I �,G City �9� f�� V Zip
(include sun or floor)
PRIMARY CONTACT
Who should wwee call/write this project? (�{ 1 �.S 2-662-ks&
1concerning
Address : _` J () M • ►/lrl L i6�t City ✓l State Ziiz_�Iaq
Office Phone: ( � h �u Cell # Fax # E- mail !
APPLICANT INFORMATJPN ��"" �^ I/ �; ' ` ,yam
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Business Name /Type: r {6h �iVS !� 20yU
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:
*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 Iwill abide by them.
�GOW
Signature X: Printed 'ie,V KI S
APPROVAL INFORMATION
[ ] Approved as proposed [ 1/1 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 s• e complies with the site plan as of this date.
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Notes: W CdY 0a.✓"-' {'14� , &M my-'t? i -11 ;
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Building Official Date o
Zoning Official Date >
Other Official J%6J - 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
17y
Intake to complete the following:
❑ YES NO
Is use in LI,W or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES V 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 o u ' water?
If private well, provide He lth'Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or pU li sewer?
❑ YES , / NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES V NO
Will there he any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 'Tech to complete the
Violations:
❑ YES F-51 NO
If so, List:
i
Variance:
❑ YES 1 NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
4/ES ❑ ,^.� IAA w t/
Permitted as: ro
CW 6y( I AA e
Under Section:
Supplementary regulating section:
�/� 0i
Parking formula-
Required spaces:
❑ YES ❑ NO O
Items to be verified in the field:
Proffers:
❑ YES 0 NO
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 of 3