HomeMy WebLinkAboutCLE200800071 Legacy Document 2013-01-11Application for
Zoning Clearance
^`ti lll' AL:!'
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # Q469,000'7 I
PLEASE REVIEW ALL 3 SHEETS Check # 4R611 Q Date: - b
Receipt # 7e>>f Staff: VT
PARCEL INFORMATION
Tax Map and Parcel: 1-117 U ` :)V(
Parcel Owner: Gdaar-
Parcel Address: q 7S-PW Qh
(include
)-60 - -D
or
PRIMARY CONTACT �y-
Who should we call/write concerning this project? G� �--�
Address: /1060afh` Idin City
C )L
Office Phone: Cell #
Existing Zoning P6
Ckl -loklat State V14 Zip °Y
/,L G —,)A /e 161,ol'�zl
State /yo Zip
Fax #&N'i D '163 E -mail J1at4�1,X6^&1WV- . Wfh-\
APPLICANT INFORMATION �j
Business Name /Type: ZIC i��l'� e I'WA.0, �cr�J�! P �17�� l�%l %� �l i���0 fop/►'
Previous Business on this site /'CAF /y/cgf/A,1a- / 41- '
Describe the proposed business, including use, jjWnber of eJ l /oyee , numb r of shifts, av
additional information that you can provide: Pr r�x� i%d �r��,a�y ciXe 01 L
and any
*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.
Signature ,� e Printed /Da ` e /�`�� J
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] 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 4 I do d—
Zoning Official 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 d ' NO
Is use in L , HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES 2r NO
Will then e 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 Cub�—lic �wate)
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sew -?
❑ 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 #
Zoning Tech to comDlete the followin
Reviewer to complete the following:
Square footage of User
❑ YES ❑ NO
Permitted as: o
Under Section: Z--L/• Z'
Supplementary regulations secti
Z y 2, / 61�
Parking formula: / I
&,4ZieoZ L SiA-- L)4-9
Required spaces: Z
❑ YES NO
Items to be verified in the field:
Inspector :
Notes:
Violations: Proffers:
❑ YES NO ❑ YES 7 NO
If so, List: If so, Lis/
Variance: SP'
❑ YES NO 7 YES ❑ NO
If so, L� -r If so, List:
v2_2�
Date:
5/1/06 Page 3 of 3