HomeMy WebLinkAboutCLE200800082 Legacy Document 2013-01-11Application for
Zoning Clearance
OFFICE USE ONLY
P Zoning Clearance = $35 CLE # ,�00 ,)>, FA
PLEASE REVIEW ALL 3 SHEETS Check # lova Date: O
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 05� f-1-00 - 00— 6)01600 Existing Zoning /91) m �--
Parcel Owner: S K0 9P E S e5- C1 o'v �,+wN L -- 6--
Parcel Address: - % -7S' ,A �-C,& L' City C ,&,11-7- 4?-+ State Zip
(include suite or floor)
sir l °t'r,-S f O 103 (� "i� ( O S
PRIMARY CONTACT
Who should we call /write concerning this project? G (ArL t Lo ,, c-
Address : �z ., E3o;l "900'7 0 -9 City. C Q a.�- State Zip2�
LIS
Office Phone: &h n a .5321 Cell #
Fax# Of -.14 M67-mail &A3UdQ \6usLG- ,- wca. t
APPLICANT INFORMATION P
Business Name /Type: C,cLo% � i F�a ,� y WM -o f- c-t4-L- C l-".i l c .
Previous Business on this site NO Vj
Describe the proposed business, including use, number of em loyees, number of shifts, avail ble parking spaces and any
additional information that you can provide:
ti >00 V M Ak
*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 ��--ti- e - Printed Gr �A ' CZ. -Y � � � d W
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, 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 ba 6,v
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 dNO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
F-1 YES [Rf 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
7 FAX DATE
YES ❑ NO
Is parcel on private well ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dep FAX DATE
YES ❑ NO
Is parcel on septic or ublic sewer?
Ed YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
W YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 1 A C--
Zoning Tech to complete the following:
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
2 YES ❑ NO -
Permitted as: 2 1
Under Section:
Supplementary regu ations section:
ti q
Parking formula:
Required spaces: /� i
l ,lT ✓Q.l� C�iL�'G��
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
Notes:
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
Date:
5/1/06 Page 3 of 3