HomeMy WebLinkAboutCLE200800110 Legacy Document 2013-01-16Application for
Zoning Clearance
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # Q 6 65? Q06
PLEASE REVIEW ALL 3 SHEETS Check # 2A'21 Date:
Receipt # 70K 15 Staff. 1I
PARCEL INFORMATION
Tax Map and Parcel: 0/-/3-.2
pp ALA
Existing Zoning P/—) 5
Parcel Owner: ( V Y 1`C�t CL y c5
Parcel Address: 1 y �2 ° C City 01�p ( State V Zip gi
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : �` U' Dx- f City f kC� E �� ��`�)I Mate �✓ (/� Z►p
Office Phone: k3( :J` (g— Cell # L3r , V/—t 0 max # E -mail Ua etif re-A4. I f Pct rjk. l
APPLICANT INFORMATION
Business Name/Type:,t7ut f�
Previous Business on this
Describe the proposed business, including use, number of
additional information that you can provide:, !,k-Al_
icti�P�n tt 'V1_ fo,_4
number of shifts, available parking spaces and any
WE
*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.
S ignatur H /GC- Printed"`
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 J^
Zoning Official Date J
Other Official . Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
M�
Intake to complete the following:
❑ YES ,Z NO
Is use in L�, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES 2f NO
Will therAe 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 w4M i public water?
If private well, provid alth D pat mer t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ N
Is parcel on sep -, or public sewe
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # -JILM,
❑ 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:
Square footage of Use:
7 YES ❑ NO
Permitted as: --/—I
Under Section:
Supplementary regulations section:
Parking formula: )
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector:
Notes:
Violations: Proffers:
❑ YES P71 NO ❑ YES/ NO
If so, Lis : If so, Lis
Variance: SP's:
❑ YES ;Z NO El YES Ej NO
If so, List. If so, List��
Date:
5/1/06 Page 3 of 3