HomeMy WebLinkAboutCLE200800067 Legacy Document 2013-01-11Application for
Zoning Clearance
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
OFFICE USE ONLY 1j]� ,�
El Zoning Clearance = $35
CLE # CIA %_0
Check # 0 Date: -
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 (4 00 - 00 - 00 - 1-610 0 Existing Zoning -P bS C,
I
Parcel Owner: 51npt>iric 51,11 o ASs0 C IO�t' 5
Parcel Address: Ito 3t �0 W City 1o'li.�Stl�li.e.. State o- Zip
(include suite or floor)
PRIMARY CONTACT /
L,ff!2& 4A., C 7Qt.
Who should we call /write concerning this project? __�0� 1A• VU
Address : ZS75s` _ 0j1' ►YR w . City A0 A_ 13 State �Q Zip
'I4 i 1
Office Phone: ( ) - Z`i Cell # `J'J�' ! Fax # E -mail
APPLICANT INFORMATION I
Business Name /Type:
Previous Business on this site
Describe the proposed business, including use, num er of employ es, numb pr of shifts, av ilable ark* g spaces end ny ./
additional information that you can provide: lA ✓Q• r 2 �fp i
o P.2.S 'AL t O ;Q A.A 4>11,Lt eA4i`e/!j A644.
F 19
*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 b- t of my knowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
L-IAIL), Printed A
Signature 1J
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, 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 Date
Zoning Official Jb Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
Intake to complete the following:
❑ YES JZ NO
Is use in le/f, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES FZI 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 o ate ?
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 a is sewer
21 YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. / O$
Permit # 7
❑ YES NO
Will there e any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to complete the following:
Reviewer to complete the following:
Square footage of Use: �&,V2 e-jtzt "
YES ❑ NO
Permitted as: �4AO E,{' / ✓��AY `A!�
Under Section: Lit, P- Vwzf;" G
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES NO
Items to be verified in the field:
Inspector:
Notes:
Violations: Proffers:
❑ YES ,� NO ❑ YES x2i NO
If so, List: If so, List:
Variance: SP's:
[] YES ,� NO [Z YES ❑ NO
If so, List: ''If so, List:
Date:
5/1/06 Page 3 of