HomeMy WebLinkAboutCLE200700136 Legacy Document 2013-12-13.Application for
Zoning Clearance
OFFICE USE ONLY
Zoning Clearance = $35 CLE # t '7
PLEASE REVIEW ALL 3 SHEETS Check # Date: -,c) _
Receipt # K Staff:
PARCEL INFORMATION
Tax Map and Parcel: 060/00 oo QD l3,, Qo Existing Zoning
pF Af,LIF,I
Parcel Owner: C V'_��„ ; s
Parcel Address: /- j 3 k City �����T7��ti —, IT State V A Zip 22 d)
(include suite or floor)
PRIMARY CONTACT / ,
Who should we call /write concerning this project? t' �r�� li6 t_n.*j=:-
Address :� &.18oy $1.7y City tote Zip
Office Phone: # Fax # %- g i( E -mail 11A kA47Y , 4 1/00
APPLICANT INFORMATION
Business Name /Type:
Previous Business on this site
oOW/ hum
e -UY-Y7
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: r">P� -�-� �) e§AJ L—
*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 p nission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowle e. I have read the conditions of approval, and I understand them, and that I ill abide by them.
Signature Printed 4CY44 . 1, 54
AP/PROVAL INFORMATION
[/] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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
Zoning Official
Other Official
Date
Date SIB -Z/-6'%
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
,0Gl-
Intake to czlete
❑ YES the following:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES !O
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 El"NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. F X 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 C� =ion �rrebovations?
Will there be any new constru
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to complete the followinLy:
Reviewer to complete the following:
Square footage of Use:
,YES ❑ NO
Permitted as:
Under Section: A- - nr ► �4/
Supplementary regulations section: �r
Parking formula: (�
2 f/1
Required spaces:
❑ YES NO
Items to be verified in the field:
Inspector :
Notes:
Violations: Proffers:
YES F-1 NO F1 YES � NO
f so, List: If so, List:
Variance: SP's:
,Z YES ❑ NO ❑ YES ;?r NO
If so, List: If so, List:
U
Date:
5/1/06 Page 3 of 3