HomeMy WebLinkAboutCLE200700154 Legacy Document 2014-01-22Application for
Zoning Clearance
�OF. A1.I)yl
R l�,
[r Zoning Clearance = $35
OFFICE USE ONLY
CLE #�
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0(01 u.)d - OZ -0 Q- 00100 Existing Zoning 0—n r-n
Parcel Owner: ,4l R F ri nj-- 8�
Parcel Address: / Zlm 5 ND le TrL City Chv'i i 1 -0— State l /c(.. Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 2- l~ 0, C
Address: 621q L1 I15c"I-C -01., y021 9 City C� �Ul 1 e State U Zip 2Z-C#
Office Phone: l [r� t l 2c "i S� ^� Cell # Fax # 2-qS -03`fi-4 E -mail d b. 2iS -h -z l g- 3c, C
APPLICANT INFORMATION r _
Business Name /Type: TP031ii1-, T� • (Al/bLt+1 �� AJ �'n- -�
Previous Business on this site ��YV4 1a'-L
Describe the proposed business, including use, number pf employees, number of shifts, available parking spaces and any
'
additional information that you can provide: c4s ✓l c"-"o
reoe'G e CA", Sic: e I o
zoos
*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.
Signaturf"D &Lt � ��3 w Printed 0(9- UZf— D 4
AP ROYAL INFORMATION
[Approved as proposed [ ] Approved with conditions [ ] Denied.
[ ] Bacicflow 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 Date
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
5/l/06 Page 2 of 3
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Intake to complete the following:
❑ YES 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 i epartment 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 Ter \ Q S l
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # -7-49
❑ YES [9 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 'I'ecll to complete the tollowmg:
Violations:
❑ YES KNO
If so, List:
Variance:
❑ YEANO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as: - 0 W
Under Section: Y k1—A el rte/
Supplementary regulations section:
Parking formula:,
Required spaces:
❑ YE, NO
Items to be verified in the field:
Inspector : Date:
Notes:
SP's:
❑ YES NO
If so, st:
5/1/06 Page 3 of 3
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