HomeMy WebLinkAboutCLE200800184 Legacy Document 2013-02-19Application for
Zoning Clearance
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oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE NLOY.
CLE #
Check # / 2 Date:
Receipt #. 5,3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: % /� Existing Zoning
Parcel Owner: S 140 P)O l- N e; C� /1i?'t { 99;0 c L f .S1 ~ ,M ary �Cg%9J?7
Parcel Address: � l• 00 E. R:r0 � � City CdAfC'�_rr&J 1A0State et Zip Qa %l
vet
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this pi �P •4{ ELI.(�S }4 ��•. 6� `[K
Rill C096�1)12�w cov4 -C 0-101 Mr* Nfk5S+i5 _� l4_ 70to9
Address: — City "' " ' ate �
Office Phone: `7Rcj -4 o2 6 Cell # 3 �2r -S�1/ Fax # E -mail 'yb$ i�_ P 14 R 1 rt sir . f
APPLICANT INFORMATION
Business Name /Type: N " t' 1` PN e R� f Ia N P f -T f-
Previous Business on this site ��1 t-}3 -o Pt
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: Pi R P rc i N S. 14 A 1f 0w+, e N
6•-001:� S SpLeS n C"C v" — OCA 3`•"r
*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 Printed Y0.5 E P H A LL- •deS 11
APPROVAL FO TION
[/] 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
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
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Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 2/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 o ~u ��— A
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO - - ----
Is parcel on septic or p is sewe ?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES EJNO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1'ech to comDIete the
Violations:
/Q YES ❑ NO
If so, List: J/}
Variance:
❑ YES 40 NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
N7/ YES ❑ NO CC
Permitted as: T •n, ��e_
tol
Under Section: 441;m P
Supplementary regulations section:
Parking formula:
Required spaces:
-trll oer- 1.
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
5/1/06 Page 3 of 3