HomeMy WebLinkAboutCLE200700257 Legacy Document 2014-04-28r
0
Application for
Zoning Clearance
tiOk AI.Uv't
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
CLE # o? dc)% d t_a 5 7
Check # 1069 Date: o 19' d7
Receipt # &7:577 Staff: e .t
PARCEL INFORMATIO/N o �, a — e0 -�5 ` -106
/ /a,
Tax Map and Parcel: 10, i 0A r Od l< 6 % , 4 e- Existing Zoning /` 7 �;G
Parcel Owner: V"7 r d r' ! / •� �Pi
Parcel Address: 1407-1 T4 City �Ar State V A Zip
(include suite or floor)
PRIMARY CONTACT 7
Who should we call/write concerning this project? �.. /z �Gi -1-le n 6 „') Je-7 --
Address: Z4,<e 07- - City z/ .t �- s,'Mate VA- Zip %Z2-,2
Office Phone: mil'” ��jlo �I 0Cell # J.z�� Jr Fax # ,=�/G 1j-_�- // E -mail �j G�oh�i �•Qwr tL >�
APPLICANT INFORAeTION /
Business Name /Type: G� 5d n �r� i CG C� sv r Gi ✓�
Previous Business on this site o JGi-d S-4,60,-7
Describe the proposed business, including use, number o.f employees, number of shifts, available parking spaces, nd any.
additional information that you can provide: I r� �, v� hT41
*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 B is n to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I hayle read the conditions of appr a ,and I understand them, and that I will abide by them.
Signature Printed ��--
AP OVAL INO- ON
Approved as proposed [ ] Approved with conditions [
Bacl ow prevention device and/or current test data needed for this site. Contact ACSA, 977- 511,R*Aflow Device and/or
[ ].No physical site inspection has been done for this clearance. Therefore, it is not a determinati dCwr%Wi ttDh4" zgie
sl a plan. Contact ACSA 977 -4511, x 1
[ ] This site complies with the site plan as of this date.
Notes:
Building Official A Date
Zoning Official Date /P /�7 2ooq
Other Official jilj ,� 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
J Z:l _
9
r
Syr r.
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
MYES ❑ 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
ZYES ❑ 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. FAX DATE
❑ YES ❑9' NO
Is parcel on septic or public sewer?
YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES [1NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
r,oning 7recli to complete the tonowing:
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
/ a .19 0
EYES ❑ NO
rmitted as: - �,lyl� C 2b(is�lc'YIf1V�
Pe
Under Section: R'£J
Supplementary reg�lattions section:
Ct
Parking Y r roto
Requir ces:�
❑ YES 0 'NO
Items to be verified in the field:
SP's:
❑ YES ❑ NO
If so, List:
511106 Page 3 of 3