HomeMy WebLinkAboutCLE200700113 Legacy Document 2013-12-12L
04/24/2967 17:44 9103136141 HALE BUILDING CO
Application for
Zoning Clearance
PAGE 03
OFFICE USE ONLY
] Zoning Clearance = $35 CLE # ZOO
PLEASE REVIEW ALL 3 SHEETS Check # 2-05, Z Date:
Receipt #3C3'� Staff:
PARCEL INFORMATION
II
Ts Map and PArce1: L aJ 06 "n 0 '/O6- cl� / Existing Zordn� /. A L.l i%A ye(/50,m Y
Parcel Owner: ril L_ ll i!� ! r(G� 71 y. /�t� CJ D %L�IiA, 1Nl xl�i � 'T'/ A21
Parcel Address: v1 State Zips/ /
(include suite or floor
PRIMARY CONTACT n J
Who should we call/write concerning this project? -9' c
Address : 12d LtC- � City J�/� i ql, ,State H( ( Zip L�
Office phone: ) Cell # � = k Fax # - .4 E -mail
APPLICANT INFORMATION
Business Name/Type: G
Previous Business on this
Describe the proposed business, including use, number of employees, number of shifts, available parkain g spaces
a ditional information that you can provide: -0�/ 1 .
ife
*Phis 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 bas f m knowledge. I have read the conditions of approva4and I understand therm, and that I will abide by them.
Signature Prints
APPROVAL INFO ON
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 13ackflow 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 �-
i Date `-1 i�.�b f -0Z ,
Zoning Official Aate
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
64/24/2667 17 :44
9163136141
Intake to complete the Mowing:
❑ YES T]� 0"
Is use in LI, HI or PpIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES
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 Ej• o
Is parcel on private well or public water?
If private w11, pro ealth Department form.
Zoning review can not begin until we receive approval fzom Health
Dept, FAX DATE
❑ YES 9-1<0
Is parcel o i!oz or public sewer'?
❑ YES [0,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, obtai the o erPe it.
Permit # 2, - (p
to Complete the
❑ YES VNO
If so, List;
Variance:
❑ YES E(XO
If so, 'List:
HALE BUILDING CO
Reviewer to complete the following:
Square footage of Use; A 90
AYES 7 N
Permitted as: _- ; _�" G "1 L
PAGE 64
Under Section.: ' -1 JA G - d`sA - a - f C (-)
Supplementary regulations s
Parking formula Z�� `° `L &())/
Required spaces:
❑ YES 9 NO
Items to be verified in the field;
Inspector
Notes:
Proffers:
6�'XES ❑ NO
If so, List;
Date:
8P'
[YES ❑ NO
if 8*310 01, -2-1
51IJ06 Page 3 of 3
04/24/2007 17:44 9103136141 HALE BUILDING CO
P
a----
S----
Q---
(a)--
Om
4CE
2
V)
O
61
La
2
i�
SY
1