HomeMy WebLinkAboutCLE200800063 Legacy Document 2013-01-11Application for
Zoning
OFFICE USE ONLY
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L�Y�'
E] Zoning Clearance = $35 CLE # Q 669:x�ob�
PLEASE REVIEW ALL 3 SHEETS Check # I Date: 3 -a 1-6
Receipt # &ZAW Staff: 'V'i
PARCEL INFORMATION
OW ,1I.I1F•t.
Tax Map and Parcel: b I bb ' 06 7d6 Existing Zoning P
Parcel Owner: -6 �&r uk3 Q d6 `-�
a G 1 F d City Parcel Address: (16 °l�sul //e State
(include suite or floor)
PRIMARY CONTACT I \ ,
Who should we call/write concerning this project? ����' (��h 1 Q�� , f, vet�pmf' C'm te
Address: 120 W & d O(4 SGhOO 1 -pA , City C��Ie 1 I GJ Vi) (X, State VA- Zip 2,29 O
Office Phone: (']'3013 "494� Cell#i` 33o -3932 Fax# q -1'3 --1f t09 E -mail krl feviour @-cUlc�dorf„
01.3
APPLICANT INFORMATION /
Business Name/Type: C h a r i v 4eS wi l k' 1n(6cIGI o r JGIiI �, �ytG�P�i!^G{t71� �Gy l
Previous Business on this site j2-
Describe the proposed business, including use, number of em�ployees, number of shifts, available parking spaces and any
additional information that you can r v' e;o_ $0 r i r+A l-1,� kld V-AA Ste✓ - f V - -0-w S Gh�� ('S ct.,,nvim'., Kyrjena
Cak-441 lbeu./ Ges � v� y � P � �� � ,
*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, andf I' understand them, and that I will abide by them.
Signature 5 , (.. z _ �?.dL. �— Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions enied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451 , 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
Zoning Official -t
Other Official
Date :�-i i 0
Date
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 7NO lete the following:
El YES
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engin er'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 be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonino Tech tO .COmDlete the followine:
Reviewer to complete the following:
Square footage of Use:
YES ❑ NO
Permitted as: (iVL2�
Under Section:
Supplementary regul�gns section.
Parking formula;,
w
Required spaces: It- !1 j M.
❑ YES ❑ NO
Items to be verified in the field:
Violations' ""
F-1 YES / NO
If so, List:
Proffers:
❑ YES 04N0
If so, List:
Variance: /
❑ YES S2 NO
If so, List:
SP's•
YES ❑ NO
If so, O.
A0
,.760
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5/1/06 Page 3 of 3