HomeMy WebLinkAboutCLE200800048 Legacy Document 2013-01-03Application for
Zoning Clearance
ov
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 U Y Q
❑ Zoning Clearance = $35
CLE # `'
Check # Date: ,
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: lJU On !3 ) lam— Existing Zoning
Parcel Owner��nCnC�e�7 i��e, �lS���u.n � t,ta• -z. �l� l,�i �rnvv.�
Parcel Address: U.. U 0 L e,4o CityC\n r 6AL%yC State l(N Zip 22_ei0 i
(include suite or floor)
PRIMARY CONTACT
Who should w- a call /write concerning this project? l��� K(-jC\r)Ckyy-\
Address: l 1< lb ICcQ City jj(• Vjjje State lIF1 Zip
Office Phone: (� Cell #y N7 -/ Fax # E -mailrn ��eictiy►Yrn
APPLICANT INFOR9MAjTION
Business Name /Type: YJ K K) P5r1; (1 P k 0`C'"_Ab e l zseba ll _-� C' ,.n.
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: ]q(u k }i t-a w. i 1 y Yc r& l C CY c.ct e j -k e_
66C-t� S—i Si-- 1f>
*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 perinission to use the space indicated on this application. I also certify that the information provided
is true and accurate t the best of ny knowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature ' / Printed M'P'?-`/ /�• i\�~rr iaAV.n
APROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[-I INo 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 �� 3
Zoning Official Date 3 ( D
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 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 he any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to comDlete the followinLF:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
❑ YES ❑ NO
If so, List:
Proffers:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
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