HomeMy WebLinkAboutCLE200700271 Legacy Document 2014-04-28Application for
Zoning Clearance
OFFICE USE
zoning Clearance = $35 Cu. # d n a -70oa U I
>PLEA RE`VYEW ALL 3 SHEETS Check 9 U Date: —d
Receipt # -g a2/ Staff: ' J
PARCEL INFORMA'T'ION
A.
Tax Map and Parcel ; - `l a f i 4 ! Existing zoning
Parcel Owner-°' b m e. • 1 L r
: ` 5 rr � e State Address_ i%1 zip Z l�
(include suite or floor) q35 'b ✓i
PRIMARY CONTACT
Who should we calllwrite concerning this project?
Address ; I � � �e e v � `� .►!..._-City
Office Phone: t�y> Cell # Fax # E-mail
APPLICANT INFORMATION
Business Name /Type: � C G
Previous Business on this site
)Describe the proposed business, including use, numb& of employees, number of shifts, available parking spaces and any
additional information that you can provide: 5 (I I I i r-1 s- C3'.-E Ci P i^ y )c e S
"This Clearance will only be valid on the parcel for which it is approved- If you chance, 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 spaoe indicated on this application. I also certify that the information provided
is true and accurate to the best of my luiowledge. I have road the conditions of approval, and x understand th=, and that Iwill abide by than.
APPROVAL INFORMATION
]pprovcd as proposed [ ] Approved with conditions Heripei
Backflow prevention device and/or cuaent test data needed for this site. Contact ACSA, 97 -4� Baxld9ow Device and/or
[N -No physical site inspection has been done for this clearance. Therefore, it is not a detefmin io Q q i r $}ie i, gj
site plan. Contact ACSA 977 -4511, x 11'
[ ] This site complies with the site plant as of this date.
Building Official
hate i I I I "�7
Zoning Official
l
Date . jl pI-e
0t11er Official
Date
Couxxty of Albemarle Department of UommiMity .)evelopment
4011 elotire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
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intalce to complete the following:
❑ YES ❑ NO
Is utse in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineers Report (CER) packet.
❑ 'Y P-S NO
Will there be ood preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval froin I4ealth
Dept. FAX DATE
s TYES ❑ NO
parcel on private well or public water?
If private well, provide Siealth Department form.
Zoning review can not begin until we receive approval froth Stealth
Dept. FAX DATE
YES ❑ NO
Is parcel on septic or public sewer?
r�
❑ YES Z NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ER NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
'tech to complete the
Violations:
❑ YES ['NO
If so, List:
Variance:
❑ 'YP-S O
If so, List:
Reviewer to complete the following:
Square footage of Use: 6/1zlv
E?IES ❑ NO
Permitted as: �P-
Under Section:
Supplementary regulation section:
I
Parking for I
Ind
Required spaces;
)vS ❑ NO
Sterns to be verified in the field:
Inspector:
Notes
Proffers:
❑ YES EqNO
If so, List:
SP s:
❑ YES ED-go
If so, List:
5/l/06 Page 3 of 3
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