HomeMy WebLinkAboutCLE200800088 Legacy Document 2013-01-11Application for
Zoning Clearance
171 :1l, /!I.•
91zoning Clearance = $35
OFFICE USE ONLY
CLE # (,
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Check # 11,47 Date: '1411 V?�4
PLEASE REVIEW ALL 3 SHEETS
Receipt # %b'd'A Staff: `l-
PARCEL INFORMATION
Tax Map and Parcel: 06 1 yo — 90 " y20 /0O Existing Zoning ICI M D
Parcel Owner: SU GA'%2 -'tf� C'
Parcel Address: 9L1/ Glell ►Hood Shuh-k" City C9 ' V' State V/4"
(include suite or floor) La vl e ab (
PRIMARY CONTACT � ����� � � 12f� �
Who should we call /write concerning this project? /2 -
Address: (p�Q Ci&RXJZ—_—City Ci����'L� V1+ Zips �I
c /State
Office Phone: ( �l 7$ /7(0L Cell # -L /23Sa� Fax # �! t7I% d E -mail !�1 ey►`A e Small r-
S�Gt cevrt lin.� . c6yr✓
APPLICANT INFORMATION
Business Name /Type: t) ffAAI A4 &G6YF CIR-& �L Q 17Y1 Q�YS �1 N Ct Yt G% GL L
Previous Business on this site xox E
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: QFQ6&X7 NANCIA44,
O G oZCOd
C
*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.
Signatur /� " _ T rinted 40-
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APPROVAL INFORMATION
[l/J 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 si complies with tlae ' Ian as of this date.
Notes
Building Official --- Date
Zoning Official %A�( Date � s
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 []ENO
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 or_public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
�
ES ❑ 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. D EV
Permit # c!5^/ 67
[YES ❑ NO d yL
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 13a6d 570 (o 67A/G
4 20-3 - 06 N 6:T C Fie UPPI 7-�
ZoninLy Tech to comDlete the following:
Reviewer to complete the following:
Square footage of User D
YES ❑ NO
Permitted as: 5� i e.
Under Section: AE 0(ed w 0 U A 5k 4d� to
Supplementary re ulations section:
Parking formula: 0 4a
Required spaces:
❑ YES ❑ NO j
Items to be verified in the field:
Inspector : Date:
Notes:
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