HomeMy WebLinkAboutCLE200700188 Legacy Document 2014-01-221
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Application for
Zoning Clearance
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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
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OFFICE USE ONLY
❑ Zoning Clearance = $35
CLE # o
Check # b3m Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 55 Existing Zoning �3 r>
Parcel Owner: M9yfUk' M o\)Wk7,1.h PD pc (-i9 c_C -gi¢5 1< •�1 P l i�i�. (t$Iv1 � ` 1�tf� P��E_ �1( i_.
Parcel Address: -- *'?�,_ -- City C.XbTC* State VA ZipZ7_9, Z
r(incI de suite o floor— /
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PRIMARY CONTACT
Who should we call/write concerning this project? '96yin lb-
Address : re. o' l�x� ttS City r--y" [[f- State Vk Zip Uclo2_
Office Phone: �) Q�{ • (Ag4J Cell # $1S• 45�R� Fax # `i`d � Sl`BO E -mail b�-tv, ��C� t'ixs�lt'L( he�-
APPLICANT INFORMATION
Business Name /Type: S -, (n(IS Gwb CICItvic �'J.��0 nm (� c23 • C8�
Previous Business on this site Cold. "7-rk1l &zA-e 0.v6
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: -1'11 _ Revs 4- (s'6S C" o C—ycj\hc Isln�U&VCA— WA( be— lemr4 I✓
�1n2� Olcl "f`n.�L ' 10 4bu-, \ �x � 1 -2_yeS rlars � "_boor lom �aluv k�sS. i'ht
course, rte -x44x tv.`,+._) will 10 ,NV rest - a+662 k r. -n.d_ - h re_ wt`[I br a ng- !�{�' QO'
cc-+2 - lt�I --l-- ih - Fov\ -t * - f-r' Gwb k6usc_
*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 e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurat to my k e. 1 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printedt�
APPROVAL I ORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] ied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977- 45l'I, 19.
[ ] 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. �J
AH—
Notes:
Building. Official F- C��� ---z -� Date I' Z
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
.t.!
Intake to complete the following:
❑ YES j[NNO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engi er'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 rivate well or public water?
If private we I, provide Health Department form.
Zoning revie can not begin until we receive approval from Health
Dept. FAX ATE
❑ YES NO
Is parcel on s tic or public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain t e roper Permit.
Permit # Vl/
Coning Tech to complete the tollowing:
Violations:
❑ YES ✓(NO
If so, List:
Variance:
❑ YES [ /NO
If so, List:
Reviewer to complete the following:
Square footage off pU�se::
[ZYES ❑ Y,&
Permitted as:
Under Section:
Supplementary regulao�s�section:
Parking formula��4,.',^ l.,
Required spat : / t( c AJ / h6
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
YES ❑ NO
If so, Ljsi:
SP's:
❑ YES E�AO
If so, List:���
511106 Page 3 of 3
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Tax Map:
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