HomeMy WebLinkAboutCLE200800105 Legacy Document 2013-01-16}d
Application for
Zoning Clearance
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # ;7069906 ( C>,�;
PLEASE REVIEW ALL 3 SHEETS
Check # 5 Date: 5 D
Receipt # 6 Z >oZ- Staff: (n-3
PARCEL INFORMATION
Tax Map and Parcel: 1 go 0 1 8 Existing Zoning c9m/-
Parcel Owner: C9 9 1 j pr %n°
Parcel Address: L% �'�^ F&57- A City C 4 kf N Z 5 V, ' State 44- Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? J ` % . six 1, it
Address: P 0 3 aX 7/)"3 City Cd' `� State Zip
Office Phone: L ) -/ 11 yCell # f4)-_5'_)96 Fax # E -mail D 7 4A O P945 -TA "
APPLICANT INFORMATION e (��s �� M -'2t) C
Business Name /Type:
Previous Business on.this site / e r/C /'-cy- fc-!L°
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: n e 9 S /rt o V.'n 5 e/ � �ro X < <S — ��r
�PL( Trrcye/ ✓���i►T-
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's ernussion to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of y kknowle ge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature Printed
AP ROYAL INFORMATION
[ Approved as proposed [ ] Approved with conditions ]Denied
[ ] Bacicflow prevention device and /or current test data needed for this site. Contact ACS k, 9 �41ppdcl el I�'�.Ce "���
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a det n Sion of n r ce `Yli�xisti lg
urrent`'i�e' ata ceded
site plan.
[ ] This site complies with the site plan as of this date. Contact ACSA 977 -4511, x. 119
Notes
t—
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
C'9r?
I.
Intake to complete the following:
❑ YES O
Is use in LI, or PDI zoning? If so, give applicant a Certified
Engineer's Report R) packet.
[:1 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 pt is ter?
If private well, provide Healt], epartment form.
Zoning review can not begin (until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ Ntanew Is parcel on septic ew r?
❑ YES N
Will you be puttin 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 #
Zoning Tech to comDlete the following:
Reviewer to complete the following:
footage of Use: YbO
"footage
❑ NO
�}
Permitted as: ;= c�1
Under Section: %3.01. L-
Supplementary regulations section:
�a
Parking formula-
( /r)-0 () 8A-.
Required spaces lr� IMI�� X �.� g
U YES U NO
Items to be verified in the
Inspector : Date:
Notes:
Violations:
❑ YES U O
If so, List:
Proffers:
❑ YES ED NNO
If so, List:
Variance:
F1 YES ,TNO
If so, List:
M>YES ❑ NO
If so, is ✓ a 3 S f�
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