HomeMy WebLinkAboutCLE200700157 Legacy Document 2014-01-22COMMUNITY DEVELOPMENT1 Fax 4349724126
.Application. for
Zoning Clearance
Jun 7 2007 12:34pm P001/002
izoning OFFICE Un 0N11 x CleRrance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # StalT:
PARCEL INFORMATION
w-
'F;r�lE97 };
Tax Map and Parcel: Existing Zoning
Parcel Owner: y i U %r(—k -H- -Y) eS
,Parcel Address:Ty Ao,,- C -r ZPo -44L � o- Y S 4- City _ 1 �. �. State V C— Zia 0 -2
- (include. uite or floor)
PR11VIAR.X CONTACJ<'
Who should we call/write concerning this project? VVl i E' She i/l
P
Address:-10-S' M o a T1 c C U o / h! - City `I State V A- Zip ag
14 PS,ne
APPLICANT INFORMA,'HON
Business Nametrype: +413 KYl C
Previous Business on this site
a i- H `L m if S
Describe the proposed business, Including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*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 cettify that the information provided
is true and a urata to the be of my knowledcg,'e. I have read the conditions of approval, and I understand them, and that I will abide y them..
Sigaxature fie° ti l?rinted '1 tC�l2G�e to ✓i �o✓ �JCi y Ies t^
AL MORMATION
J'/J"Approvcd as proposed [ ] .Approved with conditions [ ) Denied
[ ] Backtlow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451 t , xl l 9.
No physical site inspection; has been dome fvT this c)earance. Vierefore, it is not a determination of compliance with the existing
site plat).
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Date
zouin:g official
Date
Otber official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville,'4rA 22902 Voice: (434) 296 -5832 )tax: (484) 972 -4126
511106 Page 2 of 3
COMMUNITY DEVELOPMENT1 Fax 4349724126 Jun 7 2007 12:34pm P002/002
Intake to co plete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 121NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin unW .we receive approval from Hesltb
pep . FAX DATE
YES ❑ NO
Is parcel an private well or public water?
if private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
I7ep ' )FAX ))ATE
[ Y'I;S ❑ NO
Is parcel on 7NOr public sewer?
El YES
Will y ou be putting up a new sign of any kind? If so, obtain proper
Sign perrttit.
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
if 8o, ob ' t P
k'eKmut #
Violatious:
❑ YES ❑ NO
If so, Dist:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the fallowing:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section,
Supplementary regulations section.
Parking formula:
Required spaces:
❑ 'XES ❑ NC)
Items to be verified in the field:
Inspector Iaate:
Notes:
511106 Page 3 of 3