HomeMy WebLinkAboutCLE200800064 Legacy Document 2013-01-11COMMUNITY DEVELOPMENTI Fax 4349724126 Feb 25 2008 01:58pm P003/004
Application for
Zoning Clearance
OFFICE USE ONLY
❑ Zoning Clearance = $35 ELF # o2 W g 6C0-1 L(
PLF,ASY, REVIEW ALL 3 SHEETS Che'Ck # 10 Date-_ -
Receipt # bG Staff: U-
PAIRICEL 11N)FORIVIATION
Tax M(ap and Parcel: � SJ� � �, r- OI - U O -- LA A-'D `EE,,istimg Zoning �Q C/
Parcel Owner: 1 U--' C& tom- l� V 1V1 i1� 4a— 1I0 �4' ?V) (4e.1
Parcel Address: Ci t A
- city _� ,1� _ Z;pi'a 1(i
�ctde sui
Cam' -
I'RMARY CONTACT
Who should we calUwrite`eouserning this project? �t VU
Address:— � D 1 �� C)4- City State Zip-
Office Phone l 3Z �3L4'
-il �i t R� Cell # �1�e Z.S Z Fax # 2�fq. ej` sS Email cLe�VDU 06
J[) tub
APPLICANT FOR. TIO LAGE.�^c,Y3 .
Ousiaaess Name/Type: ,k vt L` A-L L—L dC-
Previous Buskess on tbds site �;1 i
Describe the proposed business, including use"nupbpr of a Ioyegs, number of shifts; available parltfpg spaces and any
additional information that you can provide:
'"'This Clearance will only be valid on the parcel for wbtich 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 m%zer S pemaissiou to use the space indicated on this application. I also certify that the information provided
is true and. accurate to the best of = I kno-vledge, I have read the conditions of VProval,, audpI �" .d�erstand them,, and that Iwill abide by them,
Signature
AJpOVAL INFORMATION
[ tj Approved as proposed [ ] Approved with conditions
[ ] B le#low prevention device and/or current test data neoded for this site. Contact ACSA, 7 -4 e � tevice and/or
�] o physical site inspection has been done for this clearance. Therefore, it is not a det atA{ �`T' � ned
site plan. Contact ACS 977�a1 I'Asi f9
[ J This site complies with the site plan as of this date,
dotes:
Building (Official Date
r
Zoning Official Date 7d 2 �? io
Other Offacial Date
County of Albemrle Department of Co1mllopunity I)eveloPMe)tt
401 McIntire Road ChatlottesvWe, VA 22902 Voice: (434) 296-5832 Fax: (434) 97,2 -4126
5/1/06 Page 2 of3
COMMUNITY DEVELOPMENTI Fax 4349724126 Feb 25 2008 01:58pm P004 /004
Intake to complete tote following:
❑ YES 1Z NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Rcpon (CSR) packet,
❑ YES ['Aj NO
Will there be food prepaxation?
If so, gave applicant a Health Department fom.
Zoning xe'�Iew can not begin until we receive approval from Health
Dept. FAX DATE
❑ YEs ❑ NO
Is parcel on private well o �tll-
If private well, provide Health Department form.
.Zoning review can not begin until eve receive approval from Health
Dept, FAX D,A,n
❑YES ❑ O
7s paxoci on septic N oz lies er?
❑ YES DxNo
Will you be putting up a new sign of any land? If so, obtain proper
Sign pe nit.
Perinit #
❑ YES J INO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit
�0DW9 1'eCt tiD C
Viblatiozzs:
❑ YES O/NO
If so, List:
Variance:
❑ YES P/N 0
If so, List:
Reviewer to complete the following,
S az'e otage of Use: �� 8
YES ❑ NO
Pcrrrutted as: �'(l
Under Section: �- • l �) --
Supplementary rcgulatio s section:
Parking, formula, I )6
Required spaces:
❑ YES NO
IteiMs to be verified in the field:
�zzspector : Date:
Notes:
Proffers: ,�/
El YES 0/1 NO
If so, List:
❑ YES [DINO
If so, List:
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