HomeMy WebLinkAboutCLE200700195 Legacy Document 2014-01-22COMMUNITY OEVELOPMENTi Fax 4349724126 Aug 1 2007 03:34pm P002 /004
Application for y�
Zoning Clearane f
OFFICE USE ONLY v
,lioning Clearatxce = $35 OLE #' n
PLEASE REVIEW ALL 3 $BEETS Check # Date:
Receipt # % I ° I j! f� staff:
PARCEL INFORMATION
Tax Map and Parcel;,j& Existing Toning R•/"ti
Parcel Owner: QiT L (1 �� I L,Ci
p �i�
Parcel Address: %D �' S f'a� �-�t 0�w C�^ City e '102e� ` state lXt
(include suite or floor}
PRIMARY CONTACT-fro a,,te. LAe, Atet�')o, q7-7 f1'/Z Or 9.91 � (P 35"
Who should we ca11/'�rrite concerning this project?' � 6 4
Address : l til k &Q�4 ulau,-( LA /V-e city C' a,41r#e,,. /1P state _ iIlq zip
office Phone: y( 3/777 /BIZ CeU # 98/ -�? &35 Fax # dC►' ?3 3 E -mail. C 0C—CAOC 8 @ c.o I > CO3,,
APPLICANT INFO)RIVATION,
Business Name/Type:
Previous Business on this
Aescribe the proposed business, including use, number of employees, u' lowber of shifts, available parking spaces and any
additional information that you can provide: .
*This Clearance will only be valid ort the parcel for which it is approved. If you change, intensify or move the use to a ne'w location, a new Zoning
Clewpmw 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 trues and accurate to the tbest of owleda-e. I have read the conditions of approval, and I understand them, and that I will abide by than,
Signature V Printed i�pbe�� '5+PA
,APPROVAL INFORMATION
f ] Approved as proposed [Vpproved with conditions [ ] Denied
[ J Backf ow prevention device and/or curtent test data needed for this site, Contact ACSA, 977 -4511, xl 19.
[ ] No physical site inspection has been done for this clearance. Wherefore; it is not a determination of compliance with the existing
site plan.
[ ]
T his to ocrm 1'cs with th�j�ite of this d tc. /�
Notes: W l77/� % ��i • o lip � 44L 2 &4-
v
Building Official 2L. Date � l
Zoning Off cial Date �6 7
Other O icial pate —
County of Mbemalrle Department of Community Development
401 McIntire Read Charlottesville, VA 22902, Voice: (434) 296 -5832 ]Fax* (434) 972 -4126
511106 Page 2 of 3
COMMUNITY OEVELOPMENTI Fax 4349724126 Aug 1 2007 03:34pm P003/004
futake, -to complete the foaRowing:
❑ YES EA NO
Is use in LI, Hl or PDIP zonbig? If so, give applicant a Certified
Engineer's Report (CFR) packet.
❑ YES M loo
Will there be food preparation?
If so, give applicant a Health Departmont forth.
Zoning review can nol 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, - F 4.X DATE
2 YEs ❑ NO
Is parcel an septic or public sewer?
❑ YES [P--NO
Will you be putting up a. new sign of any kind? If so, obtain proper
Sign permit,
Permit #
❑ YEs 9;46
Will there be any new constmotion or renovations?
If so, obtain the proper Permit.
Permit #
( Oning ` ceh to complete the following:
Violations'
❑ YES Zp
if so, List:
Variance:
`❑ YES Q NO
If so, List:
Reviewer to complete th following:
Square footage of Use: r 1 a
0--y-P-s El -No /
Permitted as: PNWf'J �n/PA� /� 1 �d'}�h G1,4
Under Section: 11 A ;1 0 J`-A 41 Ge, U
Supplementary regulati I s section:
Parking formulae `1
Regiuired spaces:
YES []-NO
(�
Items to be verified in the field:
Proffers:•
❑ YES e' to
If so, Lis €:
SP'S:
❑ YES pro
Ifso, List:
Pate;
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