HomeMy WebLinkAboutCLE200800079 Legacy Document 2013-01-11Application for
Zoning Clearance
El Zoning Clearance = $35
OFFICE USE ONLY /'�
CLE # l� L� b
Check # Date: - I
PLEASE REVIEW ALL 3 SLEETS
Receipt # Staff: lu
PARCEL INFORMATION
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Tax Map and Parcel: yr/ K /�. -nD °(YJ " 3011 �/
Existing Zoning I
Parcel Owner:
Parcel Address: City i �� State Z4001
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? � a-t,
Address: S 0 Lv i- L (; 6C �P R City State `✓ Zip112r o z
Office Phone: ( ) `1�� S 33 ° Cell #1�� g1to � � S Fax # 3� (.}to(— S Z7 � E -mail b S cc, 0' p "� � � ' Q� \uk
APPLICANT INFORMATION
Business Name /Type: ('•y/'� o %vt`' ►/r n G nJ r' ,�j cc.,
Previous Business on this site
Describe the proposed business, including use, number of employees, nu vailable parking,spapes and any
additional information that you can provide: 7, °L' ' S r a Ile C
I'
*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 thebest of my knowledge. I have read the conditions of approval, and II understand them, and that I will abide by them.
Signature /-r, G % Printed �J %�2 �' 'y r`"n
A)�PROVAL 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 ''-( –�-
`
Zoning Official Date s1ggl n
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
In ake to complete the following:
YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Rep rt (CER) packet.
F] YES Rep
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 D/NO
Is parcel on private well ublir' wa ?'
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES 4 NO
Is parcel on septic or c se .
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 4apftld-
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the op 1? t./�
Permit # /V✓ C�`r^yl%J
OoninLy Tech to complete the following:
Violations:
r_1 YES -0NO
If so, List:
Variance:
❑ YES VNO
If so, List:
Reviewer to complete the following:
Square footage of Use: 1/10M
i
P-1Y NQ
❑ VOL• �ei/I,b66
Permitted as:
Under Section: '1• g. �_
Supplementary eg�lations section:
P-06—
❑ YES NO
Items to be verified in teyfield: ,' n
�
crY (� oh
f5-12-1 OS
Inspector Date:
1
Proffers:
❑ YES
If so, List:
93 NO
'
DYES
If so, List-
(
❑ NO
jo
5/1/06 Page 3 of 3