HomeMy WebLinkAboutCLE200700275 Legacy Document 2014-04-28Application for
Zoning Clearance
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�] Zoning Clearance = $35
OFFICE USE ONLY
CLE # ae670627�;
Check # Date: [1-9-67—
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: VF,4
PARCEL INFORMATION
Tax Map and Parcel: 6C 106 —6d--00 — 12.30?) Existing Zoning
Parcel Owner: O'C-
Parcel Address:) 5_ A(AovkAc J n &,Ai ,e- City cli' V9CZ-e State VA' Zip zzol11
(include suite or floor)
PRIMARY CONTACT ��
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Who should we call/write concerning this project? / LR'7 ltd Fr C'7E hS
Address: 312:L !" ye CAL- 121 6 c /< _ City e(i V LC ,'F State V,y ZipZ 2°(tj
Office Phone: �� )AC ^ _9k31 Cell # q'62— O7 Y `� Fax # E -mail CiV A L,'�`G ooS �►
�� � l-S7ro Ott e`er'
APPLICANT INFORMATION
Business Name /Type: 8.6 1 .Sca -LAWS CV a= 1�6� etc c A
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: SA-c Qr= C� zct� r►��45 Tste '& -r
*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 t e best �opf_m�yyknowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
�: R0 7.
Signature !x Printed 3 e?cr
APPROVAL INFORMATION
Approved as proposed . [ ] Approved with conditions [ ] Denied
�]
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 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 l (' Se. (CJA
Zoning Official ✓�� Date i
r r -
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 A NO
Is use in L 1 , HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES NO
Will there e 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 or a lic water
If private well, provide Hea rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NQ
Is parcel on septic or Asewer?
YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # o-7 —1116- /� 1
�.J T
❑ YES /f NO
Will ther e any new construction or renovations?
If so, obtain the proper Permit.
Permit #
GoninLT "Tech to complete the ionowing:
Violations: ,
❑ YES 0 NO
If so, List
Variance:
❑ YES ,F/ NO
If so, Li §t/
Reviewer to complete the following:
Square footage of Use
2voo
0` YES ❑ NO
Permitted as: �r�s„ivA� SCI e S
Under Section: /- %,�,L, ��✓ bY�c�iL�'
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES j2r NO
Items to 15e verified in the field:
Inspector : Date:
Notes:
Proffers:
❑ YES/E5'NO
If so, List:
SP's:
P YES ❑ NO
If so, List:
5/1/06 Page 3 of 3