HomeMy WebLinkAboutCLE200800081 Legacy Document 2013-01-11i
Application
Zoning Clearance
OFFICE USE ONL r
�oning Clearance = $35 C)LIE #d(% 'F"
IP>lXASF, RF.Vb1F:W ALL 3 9 HfE+.V+ TS Check # Date: V— of D
]receipt# 7055 staff.
PARCEL INFORMATION
Tax Map and (Parcel:
® ,56A- a p / -'00 --0a 1 0
Parcel Owner: MNPEA
(Existing Zoning G
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Parcel Address: 1207 Crozet Avenue City Crozet State VA 22932 -3132 Zip
(include suite or floor)
PRIMARY (CONTACT
Who should we call/write concerning this project? W. T. Mullen
Address: 505 Victoria Drive
City Staunton State VA
Zip 24401
Office Phone: (_y Cell #540 292 0148 Fax it 1E -mAR wmtmullen(&-comcast.net
APPLICANT INFORMATION
Business Name/Type: Office of Allied Portable Toilet LLC
Previous business on this site Dental Office
Describe the proposed business, including use, nuJ off employees, number of shifts, available parking spaces and any
additional information that you can provide: Offfice for approx. six employees, single shift, eleven parking
spaces
*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 ermission to use a space indicated on this application. I also certify that the information provided
is true and accycg>jc to the besm Piave read 9ndifions of approval, and I understand them, and that I will abide by them.
Signatur Printed William T. Mulls
APPROVAL I[IqIE ®A�10�[AICI[010T Bae"Ow Device 8nd /or
Cu>rre�
[ ' ]Approved as proposed [ Approved with conditions t �6� Needed
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACS - 977 -4511, X 119
[ ] No physical site inspection has bccn done for this cicarancc. Therefore, it is not a determination of comp wake h"thcrvsreis g
site plan.
[ ] This site complies with the site" plan as of this date. UIP
Building Offffdcinl Date `f t t 3
Zoning Official 81 Date d2iog
Other Official Date _(T
County of AlfDemma<rle 1(DepaTrtment of Community If Development
4011 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 52-'NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES Bi, O
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 publi ater?
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 public s wer?
❑ YES H-RlO
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 #
Cdr
Zoniniz Tech to complete the followins:
Reviewer to complete the following:
Square footage of Use:
El YES El Permitted as: -
Under Section:
Supplementary reg l �s section:
[A r
V�
Parking formu�/o6 9- v,4a
Required spaces: 4
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations:
❑ YES ❑ NO
If so, List:
Proffers:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
511106 Page 3 of 3