HomeMy WebLinkAboutCLE200700283 Legacy Document 2014-04-28Application for
Zoning Clearance
�pk ALU,�yI�
El Zoning Clearance = $35
OFFICE USE ONLY ,�j
CLE # RQ 706 2 t5 5
Check # Date: q— - i'
Receipt # �ga.2r7 Staff: 7
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION;
Tax Map and Parcel: Existing Zonin g
Parcel Owner: (L
Parcel Address: I CZ 6 ' City State
(include suite or floor)
PRIMARY CONTACT
Who should we calUwrite concerning this p►-oject? —Tr '�
�S
Address : N 6 �; .Se m'r r% j el 4 ycxl ( City CL-4 l f e ! 0 tcaa t e 1) r\ ° Zip 2--M.1
Office Phone: U Cell d�t�39) S 1 Cab 2� Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: �°
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: r tr 16 Yee
*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 o/vner's permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate to Ydles of n Ic owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed-. lez .S F 57 ei�flri�Y%
r
APP�O' AL INFORMATION
'Approved as proposed [ ] Approved with conditions Ba ~ 1'e�c —°
i i �V1 a and /or
[v] B ckflow prevention device and/or current test data needed for this site. Contact ACS e5 1Yctt
/No physical site inspection has been done for this clearance. Therefore, it is not a detele 14, n o e 977-4511, YA Ni ffx*Atir g
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date (l I ZG 0'1
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 ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES X 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
❑ YES ,' NO
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 s tic or public sewer?
❑ YES NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES Amy NO
Will there new construction or renovations?
If so, obtain the proper Permit.
Permit #
Tech to complete the
Violations:
❑ YES ❑ NO
If so, List:
,n
I
Variance:
❑ YES NO
If so, List:
Reviewer to complete the following:
Square f otage of Use:
YES ❑
Permitted as:
Under Section:
Supplementary regLj)a1iorM section:
Parking formula /j _
Required s} r)0 Jr6 o
F-1 YES (( It JJ NO�(,l�
Items to be v. rifted in the field:
Inspector : ' Date:
Notes:
SP's:
❑ YES 0
If so, List:
v
511106 Page 3 of 3