HomeMy WebLinkAboutCLE200700124 Legacy Document 2013-12-12Application for
Zoning Clearance
L(u onmg Clearance = $35
OFFICE USE ONLY r •-� j
CLE # 2. 00 "7 � / Of �{•
PLEASE REVIEW ALL 3 SHEETS
Check # �/ � S' Date: 6 -7 - 0 7
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: & / % I l Existing Zoning oo m l-n ax� y
Parcel Owner:
Parcel Address:_ 4 4 5 Gf /(� I ►41ty State Zip
(include suite or floor)
PRIMARY CONTACT /�
Who should we call/write concerning this project? Try (j(1 RD,6 U /41S
Address: ! �f'�� �. / Q ��. ��tG3EU��� City tyl.��c� State
Office Phone: 15 JNX2- Cell# /Q�i'162U Fax #YoZyS'�JZ -$L E -mail _ (Yd�Dlnd pjYO�ptr158 a f`1 tYLq .
U
APPLICANT INFORMATION
Business Name /Type: ►"Z Oi36 TrS �7��i%i �6 •�LGGTI UIIi /�.
Previous Business on this site L1 R&-7a7 )1 7—,4X
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: .STAF�IiVS Se �2✓tCC'S, .5��11PL01✓[BS; �-5;
*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 Iwill abide by them.
Signature Printed 7Z YZls U!• Q 6,9 ,Q / ill -
AP ROVAL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] 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. Bac%flow Device and/or
Notes: Current Test Data Needed
ntact ACSA 977
Building Official A, �— Date (i i
Zoning Official Date
Other Official Date
1
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
Intake to complete the following:
❑ YES 10'
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report �(CE`R) 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 ❑ NO
Is parcel on private well o u - is ;ereceive
If private well, provide al Det form.
Zoning review can not beg•, approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or ubli sew
❑ YES DN"6
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES_
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
M YES e NO
If so, List:
MM, M1990M
Var' ce:
YES ❑ NO
If so��s�: �✓ ��
Reviewer to complete the following:
Square footage of Use: 'L 16 on
[`YES ❑ NO -
.n ,^�''� IICII
Permitted as: 0 (b � � 4 ` ,))
r
Under Section: I e4
Supplementary re gu at(/i`ons section:
JAJ
Parking formula:
l
Required spaces:
❑ YES ❑ NO (D
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers: d
❑ YES ❑ NO
If so, List:
SP's:
❑ YES E�-<O
If so, List:
511106 Page 3 of 3
l' F
eM AK ROOM
RIO CENT -- 5PACEPLANt
r
I-V
,
A-. -4Vd ROEZDT 90 00 JaE