HomeMy WebLinkAboutCLE200800099 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
r�
$6
OFFICE USE ONLY
❑ Zoning Clearance = $35
CLE # 206 0 00
Check # Ga Date: -1 a
Receipt # Staff:
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: 0 �6� � — 06 0 6 U� v � Zoning
j �Existing
Parcel Owner:
�I✓
V
Parcel Address: I % . M e x City � e f Idz V4 Zip aR-29
mclud uit or floc)
l
PRIMARY CONTACT
KI,_
Who should we call /write concerning this project?
Address: , ` % /M &Q O'Ll aad d l3L / chanlo, va" � Zip
Office Phone: t� � # Fax # E -mail y �pJ
APPLICANT INFORMATION
Business Name /Type: S% ZLR
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*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 nowledge. I have read the conditions of approval, and understand them, and that Iwill abide by them.
Signature Printed 0 1V L'_
/
APPROVAL INFO ION
[ as proposed [ ] Approved with conditions [ ] Denied
,Approved
[ dlow 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
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
r�
$6
Intake to complete the following:
❑ YES �:PDIP O
Is use in LI, zoning? If so, give applicant a Certified
Engineer's Report ER) packet.
❑ YES 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
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on private well or p lic ater?
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parce on septic or p is s er?
yj f be putting up a new sign of any kind? If so, obtain proper
permit.
lit #
❑ ,YES ff NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
toning Tech to complete tine tonowima:
Violations:
❑ YES O
If so, List:
Variance:
❑ YES 21N- O
If so, List:
Reviewer to complete the following:
Square footage of Use: /XO
S 1-1 NO
Permitted as: d
Under Section: �'
Supplementary regulatighs section:
MA 9
Parking fo
Required spaces
�/
❑ YES ❑ NO
Items to be verified inpthe field:
Inspector
Notes:
Proffers:
❑ YES NO
If so, List:
S
[I NO
f so, List:
Date:
5/1/06 Page 3 of