HomeMy WebLinkAboutCLE200800043 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
OFFICE USE ONLY
CLE # of y OOer-
2TIZoning Clearance = $35
Check # Date: 1�2 _a D_10 R_
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
647 41
PARCEL INFORMATION
Tax Map and Parcel: 0(41 00 --00-00- 15:S00 Existing Zoning C d
4
Parcel Owner:
_
Parcel Address: 10 ZS� E - 10 IZ,G • City Ad& -f_ State 40L • Zip ZZ 0 I
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 170.
Address : 057 57 h,: tLk AL , t . — City State Zip ZZ01
Office Phone: L-- ) % t Cell #-S,3)- //IS' Fax # E -mail CVP U4%& l'QLD - 0 k4
APPLICANT INFORMATION I L %�
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Business Name /Type: 9y-C� �J�� ,
Previous Business on this site {
Describe the proposed business, including use, number of eyiployees, nu e�af lifts av ilable parking s aces an ny
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additioi I information that you c n provide`: 00 1J A, Itgr
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*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 n 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 tl best of my knowledge. I have read the conditions of approval, and ,I understand them, and that Iwill abide by them.
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Signature _ Printed D to
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, 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 `�..v- .� -•--. Date 1� 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
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 Pen-nit.
Permit #
Gonin I een to complete the
Violations:
❑ YES F-1 NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the
'�following:
et
Squa e footage of Use: x (`� V
n ES ❑ 0
Permitted as:�X
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
5/1/06 Page 3 of 3