HomeMy WebLinkAboutCLE200700269 Legacy Document 2014-04-28! \ Q
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Application for f-.J2 ~ 5 �3/ h h
Zoning Clearance a;
OFFICE USE ONLY
oning Clearance = $35 CLE # 2 10 '
PLEASE REVIEW ALL 3 SHEETS Check # Date: ..�3 °7
Receipt # NIZA. Staff:
PARCEL INFORMATION �yp�
Tax Map and Parcel: 6 ,3 �� —60 — C6 °' C./ 7, 000 Existing Zoning
Parcel Owner: W1, I a 0--x'1 S�,Un,O y rjl--0 -rte T a It-) rr S—
Parcel Address: j Mo UJl �� C'c ���f�.�fl.�...,6& State 114- Zip �F�f
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? C -401, A
/.
Address :VO I&1) 2-0 City -b D lie, 3 tate
Office Phone: Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: !Af 1 ddo l) �' ^Ode, 36 ,2j"-C-t C4, r l� % r / r
Previous Business on this site SA77
Zip
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: AQ_ Ar,0.VUC S d 6I m 4
*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 Printed i
AP ROVAL INFORMATION � "`�' � �` 63 f
[/Approved as proposed [Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or curren eYf st data needed for this site. Contact ACSA, 977 - 4511, x] 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.
Notes:
Building Official Date C -1 0"1
A)
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 E NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer'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
BYES 93'N0
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 ["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 ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # )Z :2 0(1 6S_31 141-
Coning "1'ech to complete the lollowing:
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
Notes:
Date:
5/1/06 Page 3 of 3