HomeMy WebLinkAboutCLE200700172 Legacy Document 2014-01-22Application for ov
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Zoning Clearance
OFFICE USE ONLY
Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check #,Jtr6 Date: 6
Receipt # (o 6 1 q � Staff:
PARCEL INFORMATION
Tax Map and Parcel: 4.5- al 1 5 l
Parcel Owner: wooye zon1C L.L,�,
Existing Zoning 6_1
Parcel Address: 61D VJ(1bTII V_ 'DsZ . SLt'�� (o City C_(- }AfZL0-tFaSViId.EState VA Zip 2015D
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? J c
Address: 6,10 (,)00,61&ARK Q2/ ✓LS JIZOCity G' 1l/ /[.L�' State UA- Zip 2-2-90
Office Phone: C4-? 1h //% r-11-29 Cell # d,-12 a Fax # 27r-//% 7 E -mail
APPLICANT INFO TION ' /
Business Name/Type: U: 7'DM /40,W C- � (//G,Q�'S CD -� /,Q /i✓ /fl A �it/C ,
Previous Business on this site Li &IOV>,
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: /1 re ul" C-�>A- S 0 ,. 62-71 40 yG��`-$, / SFf-j Gj
Z PA- P-4110G 56 AMO
*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 hue and accur to to the best of my, knowl ge. I ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature G��%'`! /0&0 Printed
AP INFORMATION Backflow Device and/or
[ pproved as proposed [ proved with conditions [' 4 9..W t Test Data Nee Jed
lay, ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451 act AC 277-211o.119
ll5i
o physical site inspection has been done for this clearance. Therefore, it is not a determination be gxig
site plan.
[ ] This site co Ii w_tthAt_he site an as�is�da��
Notes: n0 -f- �i �/
V
Building Official
Zoning Official WA U441(j
Other Official
Date cY1
Date a
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 complete the following:
❑ YES ❑ 1' VO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 0' 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 z. N
Is parcel on private well o public water
If private well, provide H Ith Depa ent form.
Zoning review can not begin un i we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic r blic sew r?
ff'YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit
Reviewer to complete the following:
Square Sotage of Use: 6 / l {V ❑ NO �^
Permitted as: ►rC1F. O F-� Ce,
Under Section: v2 • 1
Supplementary rpgklations section:
Parking formula:
Required spaces: IL
❑ YES ❑ NO
Items to be verified in the field:
Permit #CL�� Inspector
F-1 YES F NO d L '7 ` Notes:
Will there be any new construction or renovations?
If so, obtain the operit.
Permit #
ZoninL- Tech to comDlete the following:
Date:
Violations:
❑ YES [P NO
If so, List:
Proffers:
❑ YES
If so, List:
ER NO
Variance:
❑ YES NO
If so, List:
SP's:
❑ YES
If so, List:
NO
511106 Page 3 of 3
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