HomeMy WebLinkAboutCLE200700155 Legacy Document 2014-01-22Application for "4A1j'
Zoning Clearance
OFFICE USE ONE
ET-zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: (o—(4-07
Receipt # Staff:
PARCEL INFOR J9N .. �,� —i?— 0 0 f C Q
Tax Map and Parcel: 61&1 4466' "'"' M2 Existing Zoning
Parcel Owner:., - 1�� i bs� +9 L"-, —C /r -"0 %R S � -►
Parcel Address: I.C:e a' t� j , ! l City _ (YC!(5�0 State+iY� Zip
PRIMARY CONTACT ^
Who should we call/write concerning this project? 1 ) .odm- (L LIS Curl Zl
Address :(Oq i<'I) 1-5k-e U • , S = 9 City C� ' Ui 1 (--e State UA Zip ZZ
Office Phone: Zt'15 Q ?b Cell # Fax # 2ciS 3'�-4 E -mail ��C,r a:, S C(h7z� .s<<6--LC
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APPLICANT INFORMATION ej
Business Name/Type: -Tesst � J� to _ __ _ - -rua ' `
r-'-
Previous Business on this site Si i� t �r'L 'E.it�� �t ::).::�'�,Q•' -�C�� � _
Describe the proposed business, including use, number pf employees, number of shifts, available parking spaces and any
additional information that you can provide: fikF (ACC t tS}✓1� c"Co ec v3C�-e S
U Ne a 7-j Z oo-7
*This Clearance will only be valid on the parcel for which it is approved. If you change, C tensify 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.
Sign aturc-Dk rt.� �3 cti -cam Printed 0(o-
A ROYAL 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 4�ta
Other Official
Date 01��"�
Date 'C1/ /-/U7
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 7X0, ete the following:
❑ YES
Is use in LI, HI or PDIP 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 ❑ 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. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer
❑ YES ❑ NO I Q rV, (� S C.0 KY_i
Will you be putting up a new sign oiany kind? If so, obtain proper
Sign permit.
Permit# 2-00-7-5C
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the followinLy:
Reviewer to complete the following: n
Square footage of Use: i.y5 dc, wool' -duo
❑ YES ❑ NO
Permitted as: ' f jo
Under Section: prj4 L- +, t'-
Supplementary regulations section:
Parking fonnula:
Required spaces: !
❑ YES NO
Items to b verified in the field:
Inspector :
Date:
Violations:
❑ YES XNO
If so, List:
Proffers:
❑ YES NO
If so, List.
Variance:
❑ YES., 'NO
If so, List:
SP's:
O7 YES ❑ NO
If so, List: qp
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