HomeMy WebLinkAboutCLE200800068 Approval - County 2008-04-04Application for
Zoning Clearance
1`2
Zoning Clearance = $35
OFFICE USE ONLY
CLE # (Q Q�
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # WIVb 3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: T M 4 5 --7 1 Q n d TMI `f', j -� �- Existing Zoning
Parcel Owner: (' V Q h h W a+ e r 7 ASP I A) e.l,- ALL f�`p1 l� r 1 -1- i
Parcel Address: ,- t0 w v 0 d bLA Ii 1) P-OI City C,� a I/ (7 1T�j Wi � bate V � Zip °L�QO �
(include suite or floor)
PRIMARY CONTACT
S r o h
Who should we call /write concerning this project? rn PS
Address : 95 tA 001'x'. -.S l .r e f— L0 he City C k a (I 0ff�jVi Atate V P� Zip a-A COL
OfficePhone:6-3AI q�7- a�7V Cell #�434)�G�rv1iO Flax# `F- �is'1f`� -mail iY�slhi�(nhl� r I�QhhCp.o/r��,
APPLICANT INFORMATION )) ( c� ( y
Business Name/Type: k j y Q.h h Q � 0 to K G e_�� V ���t� G✓ t Tv a �' ! 1 C2 �ti� /, I ►%I
Previous Business on this site
Describe.the proposed business, including use, n her of employees, number of shifts, availabl parleing spaces and any
'T L� Y�
additional information that you can provide: I h e
I-E �/ h ,-` + w c Ad e
0- ce S I' h a I J + 6—
*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 I will abide by them.
Signatui I rinted I" l I (,fit P� l P► m D S 0 h
APPROVAL INFORMATION
[ ] Approved as proposed [ V J 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 has been done for this clearance, Therefore, it is not a determination of compliance with the existing
site plan.
[ ]This. sg complies w't� h the sit Ian as of this date.rr�W
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Notes:
Building Official Date
Date
Zoning Official
1V
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 U "'NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES Q /NO
Will there be ood preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES 0 NO �-
Is parcel on private well or Fu u lid c ter?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or publicwer?
❑ YES NO
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete �the following:
Square footage of Use: _ ICI ! =
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: A, I A
Required spaces:
Lf YES U NO
I ms to be verified in the field: (Cr 0�(
y% � Sv RLP— �" 44d ac CV19-
If so, obtain proper1���/�.rt1��.t�.e�
❑ YES W1 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Toning Tech to comDlete the following:
Violations:
❑ YES
If so, List:
V NO
Variance:
❑ YES
If so, List:
60
Inspector
Date:
511106 Page 3 of 3