HomeMy WebLinkAboutCLE200600287 Legacy Document 2013-08-12Application for
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Zoning Clearance
OFFICE USE ONLY Z 2 9
Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # (P Date: —C)fi1
Receipt # 4e. Q(Q a Staff:
PARCEL INFORMATION
Tax Map and Parcel: r1%_ rims Existing Zoning Q p M, c,.—
Parcel Owner
Parcel Address: 15-q �j m�21 i Q � AA C da City` $ Q(6 N U & State 1
� �- Zip
(include suite or floor)
PRIMARY CONTACT
_-r—
Who shouldwe call /write concerning this project? Le n A P e J a ;
Address: �,6 ° 60y_<3( n
City 0 h'\) l ( te State �� T'C Zip -a16
Office Phone: L�) 97q'010 Cell #-'I O'LE Fax # 9 -a516 E -mail
APPLICANT INFORMATION n
Business Name /Type: (a>{� -,`7" 115Lt �CZrr LC � t� d '�fz6� L�Rc�4/ �e (Z u' CGS
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:t�St 7�7t nC�Y1c t`ro��19
*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 c P rinted
AP ROVAL� ORMATION
Approved as proposed [ ] Approved with conditions
[ ] Backflow prevention device and /or current test data needed for this site. Contact AC A, 9ag�,IffgMl f9' evice algid /or
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a det rnCrilitri4;fl9tdTft, l vlidfcrtld is ng
site plan. Contact ACSA 977 -4511, x 119
[ ] This site complies with the site plan as of this date. Backfiow Device and/or
Notes: Current TvSf rn"f --� A -- : _ __ %"cu
Building Official ` .W . Date a a 16
Zoning Official — Date /y,/S -O(
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
Intake to complete the following:
❑ YES E2 NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's 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 public water?
If private well, provide Healt 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 any new construction or renovations?
If so, obta' grop ,r Per . G
Permit# rJCJ
Reviewer to complete the following:
Square footage of Use:
YES ❑ NO
Permitted as: V
Under Section: f� . �� L, ��J �-7
Supplementary regul tions section:
tti a
Parking for ula:
�b Q Ve t
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
c awl --W
B20 s -ictS
Inspector : Date:
Zoning Tech to complete the following:
Fations: P o fers:
YES F-1 NO [YES ❑ NO
If so, ' lb t D O A6—, If so, List-
e&A Linn
Variance: Sr x:
❑ YES RNO YES ❑ NO
If so, List: If so List:
6P nPV1
511106 Page 3 of 3
Reviewer to complete the following: q�
Square footage of Use: '1- �rti/
El YES ❑ NO
Permitted as: P`6--k-�-5i AwA I __
Under Section: 1,5, 4 23
Supplementary regulations section:
Parking formula: S� y J �
Required spaces: Yi7V i JL�
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4