HomeMy WebLinkAboutCLE200800070 Legacy Document 2013-01-11Application for
Zoning Clearance
OFFICE USE ONLY
fK Zoning Clearance = $35 CLE # 001?1-
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMA,rT�ION
Tax Map and Parcel: - � ��~ Existing Zoning-
Parcel Owner: 1�D04k
Parcel Address: -&-ff. r-eery A-LA 1)4 Cite &tYjS4I iU State
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
0
4_- ,Jnr.tI
Q, .- o6Sa6
Zion 61
Address :��� V • ��(QP:,r� ®1(�,r� � �ity� y'161'i'e5l)16tate V o Zip V—Q6)
&24C ell "i �,SCoD
Office Phone: 43A Q � 3 - q &24Cell # 61- 44q " F 3Yax #4,34-c/73 ' E -mail fa4 G P__ �t> m + i as-
APPLICANT INFORMATION
Business Name /Type:
Previous Business on this site
L L C_
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: 6 Sri ce. Yoo-�- i r1r_ SV_6C0N -N4 r'aeA-Dh Z
*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 approvals, and I understand them, and that I will abide by them.
Signature R ^ � . <•a�... �`— Printed 9 0- 1 R A kEri0 ri l.l.
APPROVAL INFORMATION
[ ]Approved as proposed [ JJApproved wi �cos [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
10Ao 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: �e a5 etc c (90,W • VI O -eg (,l.ft eptf 5tti oreKe � GtI oik' ltu G>rcd .
Building Official Date o
iloZoning Official Date g
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 ;7NO lete the following:
F-1 YES
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [VNO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fiom Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on private well or public water?
If private well, provide Hea t'�i 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 aNO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES [2'NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1'ech to complete the
Z YES ❑ NO
If so, List:
Variance:
❑ YES [jNO
If so, List:
Reviewer to complete the (following: � /
Square footage of Use: I / "o
P• p�15� �/5 06'f, '
Under Section:
Supplementary reAlattiions section:
Parking f Ir��o D rL
Required spaces: I-
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
%�R 2 0 1 MJ) U4
YES F-1 NO ,, /] )
If so,
a
l k(y (-s A.C.
Sp"'.
YES ❑ NO
If so, List:
5/1/06 Page 3 of 3