HomeMy WebLinkAboutCLE200800073 Legacy Document 2013-01-11Application-for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 7
CLE # o'7 i!`jb �t3 < r2
Check # Date: - e>Q
Receipt # 76 Ci Staff: v�
PARCEL INFORMATION
Tax Map and Parcel: (Q - OO- UC7- 00 — _�� �� Existing Zoning L)-5 C
Parcel Owner:_
f
Parcel Address: ,� ` i 0 K-(V, �. City �iVa -f Ite o Tate NJ A- Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 4a
Address: Y C� �)( �� l l ( City �_VD 6 1111 f- State 4-- Zipd'o U
Office Phone: ( �� %D'�S / Cell # E -mail uh yr3� ' ✓��" /�d x r7'G °'��% Lt -13 ;� f�c.r��it� )m t- if.
APPLICANT INFORMATION
Business Name/Type:
Previous Business on this site
Describe the proposed business, including use, number of em loyees, number of shifts, available parking spaces and any
additional information that you caVrovide: �fb [g � � is �Sc1 C,P
ao�
*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 permiss' n to use the space indicated on this application. I also certify that the information provided
is true and accurate to i best of my knowledge. I h e read the conditions of approval, and I understand them, hd that I will abide by them.
Signature Le Printed & G_Aik 9u /'
APPRO INFORMATION
] Approved as proposed [ ] 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 site complies with the site plan as of this date.
Notes:
Building Official Date `{ -L(
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
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1.
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES ❑ 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 or public water?
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 public sewer?
❑ 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 Pen-nit.
Permit #
Zoning 'I'ech to complete the tollowin
Violations: .
❑ YES ❑ NO
If so, List:
Variance:
❑ YES - ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
5/1/06 Page 3 of 3