HomeMy WebLinkAboutCLE200800046 Legacy Document 2013-01-03Application for
Zoning Clearance
. County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
t_ �� �n L� 0/..73 J Z.00 5/1/06 Page 2 of3
OFFICE USE ONLY
CLE #���—
® Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Check # (� � — Date: °Z 2-Rlorw
Receipt # Staff: Lj
PARCEL INFORMATION
Tax Map and Parcel: Zoning D S c
Parcel Owner:' ►�'�bt� S ��.�� �� I »� ���('t `- " -
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n � � p
Address: C? % CL��`( City C y'�\AOT[SU 1 N( tate Zip A I
Parcel ,BD 1'�1'���
(include suiti or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: 1015 C -086 P kce 6 k l-D City k io/iJe- `,It DJ State Zip 301
Office Phone: qo9- 33) --/Cell # Fax Z 39391TE -mail
APPLICANT INFORMATION
Business Name /Type: �(-i Coo- � "� W 1!�2 pS° � �
Previous Business on this site-(ABC I Gl_GU 061-0tJ 40- 9V (-Y-120,� Cp— e -e-`T�k -D Z
Describe the proposed business, including use, number of em loyees, number of shifts, available parking paces and any
-�e "-0 75
additional information that ou can provide: ,TS b u1i :�2F� '_ .1
l �L �- e. coq QC 5 15l�e
*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 ge. I have read the conditions of approval, and I understand them, and that .1 will abide by them.
�T�y'k
Signature cat Printed GC— \ �� l- L
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 Date Z al
Zoning Official Date ��Z kU s/
Other Official Date
. County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
t_ �� �n L� 0/..73 J Z.00 5/1/06 Page 2 of3
T.
Intake to complete the following:
❑ YES [r NO
Is use in LI, HI or PDIP zoning? If so, give applicant 6 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
C9 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 C-
Permit # Do , J
❑ YES F� NO
Will there be any new construction or renovations?
If so, obtain the proper Permit. s
Permit # ��t,�• ��1,,, /1
Zonintr Tech to complete the following:
Violations:
❑ YES _.2' NO
If so, List:
Variance:
❑ YES Z NO
If so, List:
Reviewer to complete the following:
Square footage of Use: U .J
VYES [] NO
Permitted as:
Under Section:
Supplementary regulations section:
22.2 -.
Parking formula:
Required spaces:
❑ YES NO
Items to b verified in the field:
Inspector : Date:
Notes:
Proffers:
❑ YES 0 NO
If so, List:
SP's:
YES ❑ NO
If so, List:
9�) _ U`
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