HomeMy WebLinkAboutCLE200700267 Legacy Document 2014-04-28Application for
Zoning Clearance
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OFFICE USE ONLY
k1 Zoning Clearance = $35 CLE # aC)d 066 0
PLEASE REVIEW ALL 3 SHEETS Check # 5 Date: 163)—,6
Receipt 4. 4 90,G Staff: `V15
PARCEL INFORMA/eTIOrN
Tax Map and Parcel: U I \T Existing Zoning
Parcel Owner: C.- e yi *re- V I A i ri oc, &A CS +a-f / — (!c) ► IrY1.2i1•GCCd PY27Q+t'r6e
s L(.._L
Parcel Address: 94y Cle.490i00dJ1V )6)- -7 City �/�LI� &5U;11 e_ State VA Zip�r
(include suite or floor)k,
PRIMARY CONTACT
Who should we call/write concerning this project? sch ! e- V"
Address : /ago l-111 (76/1'" led City �. L tate 1tf/� Zipa35
�'75 �1-
OfficePhone ell # Fax # 51 E -mail
APPLICANT INFORMATION
Business Name /Type: M i (� x , I n (2,
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
i"\ z 1 n 1.^ •{- h -V /Apt
*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 true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / -'n / l - o1LujxJ ) Printed %4 GL,CN C' P11
A PROVAL 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official . c/�. A -A-� -� Date d d d o-1
Zoning Official Date _/1 Z(lo -7
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 NO
Is use in IZ , HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES NO
Will there 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 o pu is waters
If private well, provide He
me form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑YES ❑ �
Is parcel on septic r public se •?
❑ YES R NO
Will you b putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES Z NO
U e
Will there any new construction or renovations?
If so, obtain the proper Permit.
Permit #
r.onin2 Tech to complete the followinLy:
Violations:
El YES �NO
If so, List:
Variance:
,-YES 0 NO
If so, List/ .
Reviewer to complete the following:
Square footage of Use: 10 0
>j YES ❑ NO -m nn
Permitted as: A ✓a 1�6
T�n p
Under Section: Gi,u✓akY '0A- ' %tj C�J .PQ' `� 0(fA, .
Supplementary regulations section:
Parking formula: ' — N b
Required spaces:
❑ YES PT NO
Items to e verified in the field:
Inspector :
Notes:
Proffers:
❑ YES NO
If so, L' t:
SP's:
❑ YES—ff'NO
If so, List:
Date:
511106 Page 3 of 3