HomeMy WebLinkAboutCLE200800218 Legacy Document 2013-03-18r
6.,t-N" Application for Zoning Clearance
OFFICE USE ONLY
Zoning Clearance = $35 CLE #g Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # -7270 S staff:
PARCEL INFORMATION CY
Tax Map and Parcel: Existing Zoning
Parcel Owner• L---" Molk, LL Wh
i/'7c, v` c' s-rhl i Zd d
Parcel Address:- City . Ch'ville State Va. Zip 22901
(include suite or floor)
PRIMARY CONTACT ; ' P096141-1 y �Y 5 in U I •c ti �C'U rrl G`�
Who should we call/write concerning this project. 5 U sal~ 5 i-I
Address: ��i� CtJ�gfii�[ iZc� a City r 4,��rlrtjN�V1`�Q State -V i �(�11Cr. —ZiP `��`
Office Phone: C--)
Cell #. 414-!t 0-w�jl ax # E -mail
APPLICANT INFORMATION 5 � 01 2 N111 A
Business Name/Type: c, �►7e e-, t � 1 -PAC S T I R 10 0-
Previous Business on this site T
Describe the proposed business, including use, number of employees, number of shifts, available paricing spaces and any
additional information that you can provide:
// !'A-R � >nfG •f_ / H is
*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 Ir-3 • R - oC-S)t L. Printed P O 03 f O
APROVAL INFORMATION . Denied
[ Approved as proposed [ ] Approved with conditions [ ]
[ �Oackflow 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 determinatiori of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date ^ y
Zoning Official Date
Other Official rK1 av Q 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
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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'Report (CER) 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 ublic water?
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 public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑
YES'
NO
Will there be a new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the following:
Violations:
❑ YES' ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
IT-1 YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector
Date:
511106 Page 3 of 3