HomeMy WebLinkAboutCLE200700098 Legacy Document 2014-04-28SG-(.,AfPS
Application for
Zoning Clearance
�1=
2 Zoning Clearance = $35
OFFICE USE ONLY _ c
CLE # % e2C) •% t�
PLEASE REVIEW ALL 3 SHEETS
Check # i <S r; 3 Date: c4 07
Receipt # (p_rj Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0& I Yo " 0 d - 6 6— OOOG 0 Existing Zoning
Parcel Owner: S146,PV �T f ,G
Parcel Address:941 6 iell�l VJ0 aA City CM, V1 Ltc State V I "t N I •fa Zip A-490
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? CODP&- 6, w • 94 �% , �l�- •
Address : b9b �J ll�ilai Gjr CitvC- I q
LLB State VTR Zip 2; O
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Office Phone: _ '� -" ( ��p(o Cell # o943 --; G of Fax # "t -r6' Oil C E -mail ne0 Q42, 0 5 UY1.G.12T ---- P
dVl � V1a- • c� VY1
APPLICANT INFORMATION
Business Name /Type: SC-(Lt P PS Fi�3�� -1b(Ll 5 F�D�Q� Ll i�'(� �/�1J�cP� C ^�--1i✓l�l 1
Previous Business on this site �,Ao me-
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: T-1 1-JA-NLr il••C1 1L4 6L4A -aCC rYLeyJT
• O F D VM F FO f2- to. O S o
c�� 2. O T s 'r C'� o EE ICS SOJct.C45
*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 Printed VV 07(2 .
4-(,-0-7
APP ROVAL INFORMATION
[ W,Approved as proposed [ J Approved with conditions [ ] Denied
[Ij lg ckflow 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 p�n.
UA This site complies with the site plan as of this date.
Notes: ' Ayr• 027.
Building Official A Date s 13
oning 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
511106 Page 2 of 3
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Intake to complete the following:
❑ YES [?T'NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES N0
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 orpublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
ZYES ❑ NO
Is parcel on septic or public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. Ve4t---u0P e--P, G\& -N,eg
Permit # p �Q
[YES ❑ NO 1
Will there be any new constriction or renovations?
If so, obtain the proper Permit.
Permit # 132.O0 b� NC. 0012 i3 upc-
aoa�- nba�� wg.. up rI T
GoninLy 'Tech to complete the following:
Viol ions:
YES ❑ NO
If so, List:
Variance: /
❑ YES [�'NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 11966
[DYES ❑ NO
Permitted as: b Y P(,V91 Dial
Under Section:
Supplementary regfilations section:
rn a
Parking formula:C /aoo A
Required spaces: 7]
❑ YES 0 NO
Items to be verified in the field:
Inspector • Date:
Notes: Notes• v-vA
Proffers:
V YES ❑ NO
If �c�, ist: lal w n W
F SP'
YES O
If so, List: 11 ^Cnn, 1
G
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