HomeMy WebLinkAboutCLE200700181 Legacy Document 2014-01-22Application for
Zoning Clearance
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
OFFICE USE ONLY y
2007- / 9 /
Zoning Clearance = $35
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 03.xx — 00-00— olcoQ Existing Zoning
Parcel Owner /—, O, J f,w r �c A✓ /aJia,)
Parcel Address: EL'O (),. # (00 City C'la�wiy esvl��r State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? AeVaj(y
Address: � ��(5 Tvy �c/l.. City �'��,,. � , sv✓ � State
(t / `V # Zip ZZ905
/
Office Phone: ( 3V) 77 S gY00 Ce d �i3Y 7k/20 'ax # E -mail
�(T3�1) Yoy -2cz.l
APPLICANT INFORMATIO ,;
Business Name /Type: L.'.- ,os,e,e �rufe.� :, 7`�� L..nt, N�c �rC2ct, `tee "�Evu)�u
,
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
r �,%s le
additional information that you can provide: wo>,c� 4V /'s too• v�
/C
CcY /fin orh( S 1Orr'� zlrmdS /-,C, 6,,'- ✓f c7n.. fixer
*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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to th be of my knowledge. I have read the conditions of approval, and I understand them, and that I'will abide by them.
Signature /� Printed Cx - s %� 57 "tws /�� y
APPROVAL 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 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
5/1/06 Page 2 of 3
Intake to complete the following:
❑ YES EiJ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 0
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 Hea t"Th 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 [j,<O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES �O"
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Lomng i ecn to complete the tonowin
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
5/1/06 Page 3 of 3