HomeMy WebLinkAboutCLE200700233 Legacy Document 2014-04-28Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE US ,,OQN�LY� R 3_
CLE # 4f
Check # ] Z5,5r— Date: -If —0
Receipt # Staff: �6
PARCEL INFORMATION
0111 C �y /�
Tax Map and Parcel: / �� �� yb �� Existing Zoning � ✓'-I
Parcel Owner: cfcT�� 51'1
/� r /� , / q
�Pa cel Address: vZ`S �X`7�zi!_ ✓!�(�' y/ �/�- State V Zip�� l
(include suite or floor)
PRIMARY CONTACT [� j
% st
Who should we call /write concerning this project? ' %2°l G�lJrlick
Address r o7o `e-Ik 1 QNGIc- City.C{ btu jo &3L1('(/V State �GL Zip
Office Phone: CtN,) _,1 j q j 5-0 Cell # Fax # 630 7 -13 -bulb E -mail Wp[7u,.{(eL1
APPLICANT INFORMATION `` p
Business Name /Type: J�� ��' ja r� /�rr�riyr d AC= afkK C dew�J /
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:
*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 infonnation 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
APPROVAL INFO ION
Approved as proposed [ ] Approved with conditions [ ] Denied
t Bacicflow 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date j 1 i io 1
Zoning Official Date �ZC�D-
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
cor'.
A
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 [2--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 Z"NO
Is parcel on septic or public sewer?
❑ YES 2rNNO
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Reviewer to complete the following:
Square footage of Use:
[1� /YES ❑ N .
Permitted as:
Under Section: 7 • I r
Supplementary regulations
Parking formula:
Required spaces: � •� �' ��
J
❑ YES ❑ NO V
Items to be verified in the field:
Inspector
❑ YES [ NO Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to complete the following:
Date:
Violations:
❑ YES NO
If so Lis .
Proffers:
❑YES 7 NO
If so, List.
Variance:
❑ YES NO
If so, List:
SP's:
YES ❑ NO
If so, List:
5/1/06 Page 3 of 3
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