HomeMy WebLinkAboutCLE200700276 Legacy Document 2014-04-28Application for
Zoning Clearance
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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
OFFICE USE ONLY
Zoning Clearance = $35
CLE # n160 OO
Check # 11 P Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # e !R G Staff: 9��7
PARCEL INFORMATION
Tax Map and Parcel: 0 5- 6 — at •— 0 e — (7'� `i��� Existing Zoning �.
Parcel Owner: rA -AeN/t-- M LtH^Lc
Parcel Address: S 7Z8 'Ttfk&ZF ►U :, rC4 Po" City C'/L ' 7-(---7 State Zip 2z 3 Z.
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �m_T LZ rA- -P
r
Address : 3,a 1, 0 o P L e,&- 4( P� c /a City of A2 co z 7 (:� f uUeState VA Zip Z2ct ( I
Office Phone: `( 3`�) situ ^31 Cell # Fax #
A L illy ^ g (Q_, Le- U A6
APPLICANT INFORMATION
Business Name /Type: gc-f
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: (A C.0 C r- C(i 2I C f^Ap 7-4 eW-.1V- t t 1 23 1 -7 --il (L� ? ` 1 (o i
*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 ` - � s �e c:S� rtre Printed Rn 9e & -r
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, x119.
[ ] 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 �� , ;�C\�� --a -�--�� Date i (I
—
�� "� Date z
Zoning Official .%, -� �1
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 L14,141 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 ublic wat'.
If private well, provide Heal Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NOT::::--
Is parcel on septic olic se
2 YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit` (� ��
Permit # 7_5
❑ YES F� NO
Will tQe be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the following:
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 2 a of
.a YES ❑ NO
Permitted as: _fi
Under Section: 4,2 br►Q�� , `Q---
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
Notes:
SP's:
❑ YES ❑ NO
If so, List:
Date:
5/1/06 Page 3 of 3