HomeMy WebLinkAboutCLE200700279 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
511106 Page 2 of 3
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OFFICE usr,�6 x
pt' "/ 60 � 7 q
❑ Zoning Clearance = $35
CLE #
Check # 10 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 12n Staff: IL TL'
PARCEL INFORMATION
Tax Map and Parcel: 2 Existing Zoning
Parcel Owner: , !�,�c Pl bra t' 41 On Ui r2 � j 110 d`i
Parcel Address: /c 1/ )DFJ 'It City 7* 014ate M Zip
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" (include suite or floor)
PRIMARY CONTACT
Lam a 464 %L TnG�i
Who should we call /write concerning this project?
Address : v� j l �a i CJ>1(k� ��l�l�'� City f— [,07Mate L Zip , �
������ # Fax # 74OM mail 1 !J% //t �� 57fQZL
Office Phone: ( ell
APPLICANT INFORMATION �� .,�., f //11
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Business Name /Type: -A)-,5 L%C.i9 � 1 1 �1 !`i-ll i 1'9 1. �l( fl�7i�
ZLS]--V f -a n
Previous Business on this site
Describe the proposed business, including use, num r of employees, number of shifts, available parking spaces and any
additional information that you can provide: ,A ice; rt' �/lL�� %0 Q _ / ,� A
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*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 liav�,tlie owner's pen,}f�ission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the be domy knowledg �1 Have read the conditions of approval, and I understand them, and that I will abide by them.
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Si gnatuye•-- - --i'7 G ' Printed L�IC &
APOVAL ORMATION
([ � kpproved as proposed [ ] Approved with conditions [ ] Denied
[,-] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19. r
[, -] "No physical site inspection has been done for this clearance. Therefore, it is not a detet7ninati of:compliance,wit the "extsttng
site plan.
[ ] This site complies with the site plan as of this date. Current
Notes:
Building Official r Date r i i
Zoning Official Date It
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
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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 [01NO
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 lic wa r?
If private well, provide He artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on 7NO or bublicse r ?
❑ YES
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 0 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
0onina Tech to/omDlete the followinL:
Violations:
❑ YES
If so, List:
6 NO
Variance:
❑ YES
If so, List:
NO
Reviewer to complete the following:
Square footage of Use:
[f] YES ❑ N
Permitted as:
Under Section:
Supplemental (regulations section:
Parking formula /16b
Required spaces:
❑ YES NO
Items to be verified in the field:
Inspector : Date:
WIL _/.
Proffers:
❑ YES
If so, List:
NO
SP's:
❑ YES
If so, List:
WNO
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