HomeMy WebLinkAboutCLE200700119 Legacy Document 2013-12-12Application for
Zoning Clearance
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
OFFICE USE ONLY q
M/Zoning Clearance = $35
CLE # Z 007 r 1 I
Check # 41 1 o1 Date: —O
PLEASE REVIEW ALL 3 SHEETS
Receipt # (o Staff:
PARCEL INFORMATIONlLDrnl(�
Tax Map and Parcel: Existing Zoning CD (6>40KQ4 m- OW(dj
Parcel Owner:_ 1490- iG4k �•( KEW 1 �Q RAQ=, U- 4
Parcel Address: 4X VE6,� W(V <.- 96 —State Zip qAqo
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? .
Add 0D d T. AL), City ���1 f IUrJ State y Zip
Office Phone: ( 9u1 Ift-7-35((o Cell # Fax # E -mail �j%i 6d, NBC •Co "A.
APPLICANT INFORMATION /
Business Name/Type:
Previous Business on this site K�-asz
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: CA Lj— Ce,4 TeL A F-j% O4n S 1 Sot r-T
UaLAMt <C-4) ON ,4t <r= '{�Ore�Ct♦SG
*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 requir d.
I hereby certify that ow or ha e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurat to h best f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
AP ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact A SA 9Z7-451 � l i1-19.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a tertNj , jjffi 6jhe]eisting
site plan. Current Test IData Needed
[ ] This site complies with the site plan as of this date. (o17t8Ct liC$1� ti'1"J.,4s11, x Il
Notes:
Building Official " ~� Date -J .� 11
Cj
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
511106 Page 2 of 3
Intake to complete the following:
❑ YES VINO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's 7NO ER) packet.
F-1 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 ❑ NO
Is parcel on private well or P If private well, provide a e art m.
Zoning review can no egin until we receiv approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or sewer?
❑ YES �N .
Will you be putting u ew sign of any kind? If so, obtain proper
Sign permit.
P.ermi
YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
GonmL 'Tech to complete the tollowinL:
Violations:
❑ YESNO
If so, List.
Variance:
❑ YES NO
If so, Lis .
Reviewer to complete the following:
Square footage of Use:2'�
% YES ❑ NOSr nn
Permitted as: h /�. S; N Z-55 O'1""� i
Under Section: 2—!;:,, 2
Supplementary regulations section:
Parking formula: .
Required spaces:
❑ YES/Z NO
Items to be verified in the field:
Inspector : Date:
►MWAFAMMATIZI MPIN "«
Proffers:
❑ YES (� NO
If so, List. .
F SP' :
YES ❑ NO
If so, List:
1,M--57 Xyti-J7' Coll
5/1/06 Page 3 of 3
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