HomeMy WebLinkAboutCLE200800049 Legacy Document 2013-01-03Application for
Zoning Clearance
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❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # af)0
Check # 10 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: U) 5
PARCEL INFORMATION
I ` Oa - " L3,-.) Z 3
Tax Map and Parcel: Q?6 M c7J Z) 1 Existing Zoning
.Parcel Owner: n O , nn J rJ LC-
Parcel Address: ('LO 1 3 P (1'JCr S /-ts) City C N4Ak_a i t 6$Jr "- qtate Zip
(include suite or floor) Z ZS o Z
PRIMARY CONTACT /
A t— L �
Who should we call /write concerning this project? t Ao A _.. ME �/
Address: ri Q f S City L ✓ ► t- C�L� State V Jj- Zip 2 tj o
Office Phone: (� .2,1 3 3 3 66 Cell fiS 0 56 � YSJFax # E -mail
APPLICANT INFORMATION
Business Name /Type: 8)(CL. I N O JST 2 1 F. S f�j C 2 (FS TO /L 4� 1 t o"J S;F,-L V I c C7
t�
Previous Business on this site M'A S Ti 2- 2�S'1�2 ? ��/ ,S` !l ✓ t ���7 Yl �;
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: k IS ASTC/1
I 54u —C . 3 5 4AAKI. –K,. sagcES , 15 TVLJCcC j ni�w Fac.r� r 2ob6
*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, anew Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission 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.
�r 1ra Printed xA0 /1-`'l AA t--t - IJ , I�
APPPO AL INFORMATION
[V] Jp —Dved as proposed [ ] Approved with conditions Back Am
[ /] B cicflow prevention device and /or current test data needed for this site. Contact ACS 9 �9• �� and/or
V No physical site inspection has been done for this clearance. Therefore, it is not a deten i t oii o t il� INIMMin
XNA
on�act 97'7 -4511, x 119
site plan.
[ ] This site complies with the site plan as of this date.
No es: i•
4104 . (M (ii/ h1L Y 674� Kyv
Building Official Date
Zoning Official Date a
'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:
K us YES F-1 NO
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 c w er?
If private well, provide Hea rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or. Ulic wer?
❑ YES ZNO
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
❑ YES NO
Will there be arty new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin 'Tech to complete the following:
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 17470 w0
❑ YES ❑ NO ,,� I� Ace
Permitted as: r 0 �' `I ra (� f S
Under Section: 6? `' � , I(
Supplementary re r ations ct*
( r
(�
Parking formula-`��
Required spaces: ^ems t, / c--pt ��
d,w' � �t'
❑ YES ❑ NO'
Items to be verified in the field:
Inspector :
Notes:
Date:
511106 Page 3 of 3