HomeMy WebLinkAboutCLE200800057 ApplicationApplication for
Zoning Clearance
of nr,�
r7itrt� �;.
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # 260'96106-52
Check# Date: 13-111
Receipt #'i, Staff:
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATIION
,,!
Tax Map and Parcel: d `jgL -� U �d6 �� (�� Existing Zoning
Parcel Owner:
''
Parcel Address: -/-/V/61 //
/61 J VX L'-0WjW01N 9 City e-Ae lL0154TOII *State VA `' Zio:�?LO
(include suite or floor)
PRIMARY CONTACT / � ! T
/J
Who should we call /write concerning this project?
d
Address: Pd %� City state �// Zip°2 ll-
Office Phone: ( Cell# Fax 01?13IVUYE -mail
�
APPLICANT INFORMATION
Business Name /Type: 6f4",,V7- Q. IW ,�yJ,gx1, 6,J4f0g!5A -
Previous Business on this site 1446' V,Ve-77J,�L
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
AP 3 P
additional information that you can provide: Z t
7S `
*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 II understand them, and that Iwill abide by them.
Signature Printed
AP�DVAL INFORMATION
[V]�ppr ved as proposed [ ] Approved with conditions l e ��fiy beviee and/or
[/]' B elcflow prevention device and /or current test data needed for this site. Contact ACSA, 9
[�] -No physical site inspection has been done for this clearance. Therefore, it is not a detennin tibont'ol , M 07 4511, x�1 �9
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date 2
Zoning Official Date 5 y /
1
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 ❑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 h NO
Is parcel on private well or V IIh erg
If private well, provide Health D6pattment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic o ublic sewer'
❑ YES 7,/ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES �L- NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
boning Tech to comDlete the following:
Violations:
❑a "YES ❑ NO
If so, List:
Z i
Variance:
❑ YES U�NO
If so, List:
Reviewer to complete the following:
Square footage of Use: � y
[�/YES ❑ NO Z,�° /Vii 2 Gi C40J
Permitted as: Y�f-�Y1 L �
Under Section: - to
Supplementary regulations jection:
Parking formula: I 1')bG
�
Required spaces: 06-1 l
❑ YES ❑ NO I
Items to be verified in the field:
Inspector :
Notes:
F,-/]' YES ❑ NO
If so, l,i�st�
SP's:
❑ YES ,❑/ NO
If so, List:
Date:
5/1/06 Page 3 of 3