HomeMy WebLinkAboutCLE200800062 Legacy Document 2013-01-11•
� Application for
�oning Clearance
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 # [ Ig " & ,
oning Clearance = $35
Check # Date: -O4
PLEASE REVIEW ALL 3 SHEETS
_
Receipt # fnei 95 Staff:
PARCEL INFORMATION
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Tax Map and Parcel: Q ° (�(J�(�(i- l n� Existing Zoning
Parcel Owner:%o71 A
Parcel Address: City State Zip
include suite or floor)
PRIMARY CONTACT
Ze �� 6�4�'
Who should we call /write concerning this project? , "- Y^ /;
Address : 6 �I� ��r� f�C�!"' ��• dJ City L /,'L •�%-b •/,State & �� Zip 9r/
Office Phone: U i - 12L-YCell # Z�y-37 I/�f; ax # 3 3s= 9'Z' 7 E -mail
APPLICANT INFORMATION
Business Name /Type: /+ 'i IL
Previous Business on this site
Describe the proposed business, including use, nu er of employees, number of shifts, available parking spaces and any
additional information that ou can provide: ✓ /" �7 i� �f °O �,U — do ;,"/Y
GPI .. � � v✓ •- ` ` �d ,tt - .`UG = ,-• r
*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 I understand them, and that Iwill abide by them.
r �� ' —/�
Signature r% � /�' � � !� Printed
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 bas been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] Tlnis site complies with the site plan as of this date.
Notes:
Building Official Date 3T4
Zoning Official DateZiy
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:
Reviewer to complete the
❑ YES NO
,following:
Square footage of Use: �1c�
Is use in LI,i or PDIP zoning? If so, give applicant a Certified
Rep
Rep
Engineer's rt (CER) packet.
® YES ❑ O '
tjwV
Permitted as: -�
❑ YES
Will there be food preparation?
=LL'tJG(/�C�(.e
Under Section: �b b� - ' S
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Supplementary regulatio s section:
a
S(YES ❑ NO
Is parcel on private well o blic
Parking formula:II^
�V bi/�•% C'P (.v
Required spaces:
If private well, provide Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
❑ YES ❑ NO
YES ❑ N
Items to be verified in the field:
Is parcel on septic ublic sewer
❑ YES ❑ NO
Will you be putting up a new sign of any land? If so, obtain proper
Sign per"
Per, it #'
Inspector : Date:
WYES ❑ NO —
Notes:
Will there be ar ew construction renovations?
If so, obta' r er Pe t.
Permit # " lu
Gonina l een to complete the tonowm2:
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES NO
If so, List:
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES Q NO
If so, List:
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