HomeMy WebLinkAboutCLE200800077 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
511106 Page 2 of 3
OFFICE USE NLY
r'!
El Zoning Clearance = $35
CLE # R-6=b 7
PLEASE REVIEW ALL 3 SHEETS
Check # q7g 6 Date:
Receipt #. 9-D236 Staff. _IS'r,5
PARCEL INFORMATION
Tax Map and Parcel: D6J M - jQ0- DD-'GYo300 Existing Zoning G/ eo1»rne1a;&/
Parcel Owner: -7h✓ee
Parcel Address: VI) %rReNiCoe L,JRC %y S� /d3 City Lh,4k Jo/7e.Sw) Je State 1,16 Zip AR 901
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: i7b lieeMley /_i✓. S4e- 103 City State I1A Zip w
Office Phone: erje'�l3- /DS-'S Cell # Fax # E- mail (/yh4ff1S��Cd.r1»IOrVtdPct�a J,
G'dr�
APPLICANT INFORMATION
Business Name /Type: /',j MMQA1aeAA A k i/ /NcY , L L C ejweAee e4
Previous Business on this site �)e)e9a UL 4- mll .Sent/ /C eS
Describe the proposed business, including use, number of employee , number of shifts, available parking spaces and any
additional information that you can provide: 11ye&6 D- lce /3 --r7. vf'e 5 -
G,�Pri x AW9,rr6Dt}Ce5.
*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•thee best of my laiowledge. I have read the conditions of approval, a�nddII understand them, and that I will abide by them.
Signature GL,2.C�'•!!/LdO� Printed /�1C�0/21i1 �• �%�2�2)S
APPROVAL INFORMATION
[V] 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 determ=Cunent liance with the existing
site plan. w Device and/or
[ ] This site complies with the site plan as of this date. Test Data Needed
Notes:
97745!1, x
Building Official c ~- Date L4
Zoning Official ) Date LAY //0 8
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to complete the following:
❑ YES [?I'NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES []ENO
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 4c ublic 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 ublic sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES Z NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonins/Tech to complete the followin
Reviewer to complete the following:
Square footage of Use: cl
YES ❑ at Permitted as: (/ki see
Under Section: -1-LP' P' 1 X-1
Supplementary regulttans section:
Parking formula-
Required spaces: q
❑ YES ❑ NO
Items to be verified in the field:
Inspector•
Notes:
Date:
Ba'tions:
YES ❑ NO
If so, List:
p i
Proffers:
❑ YES ❑Q NO
If so, List:
n VJ f 10
y �.
Variance:
❑ YES ❑ /
If so, List:
SP's: /
❑ YES ./❑ NO
If so, List:
511106 Page 3 of 3