HomeMy WebLinkAboutCLE200700245 Legacy Document 2014-04-28Application for
Zoning Clearance
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # 966 2.06Q 45
PLEASE REVIEW ALL 3 SHEETS Check # 119 lQ Date: 16 - K -G
Receipt # e 5 Ct 4 Staff: _ j
PARCEL INFORMATION
Tax Map and Parcel: .`� - J h d —/ —1.3
Parcel
Existing
�� fJ� �� r
Parcel Addresse %a Aeez&a dkdi Pl I City. _ - State ��G. Zip as
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address :1S" ?Q" i n'4?/M 1Q,
Office Phone: (�
APPLICANT INF
Business Name/Type:
Previous Business on t
r4q- L_eane*Q.
CityC. / d& State
Cell # ft -P' W2 Fax # !-?;4"6W-mail
CC..
zip�al
CQ170)
Describe the proposed business, including use, number of employees, number pf shifts available parki i spaces and any
additional information that you can provide: /3 G[i- �77�' d/L/ - -- -
*This Clearance will only be valid on the parcel for which it is. approved. If you change, intensify or move the use to anew location, anew 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.
Signatur��� �) em n b Printed an4st /) � L[�Q
APPROVAL INFORMATION
[vi'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 determi ate
site plan. Backflow Device and/or
[ ] This site complies with the site plan as of this date. Current Test Data Needed
Notes: Contact ACSA 977 -4511, x 119
Building Official Date kc�
Zoning Official Date I IWJ4-t
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
)1 A
Intake to complete the following:
❑ YES P <o
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 6� 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 septic or public sewer?
❑ YES VNO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ENO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Gonin 'I ten to complete the tollowin :
Violations:
❑ YES Rr NO
If so, List:
Variance:
❑ YES [� NO
If so, List:
Reviewer to complete the following:
Square footage of-Use:
r''3Q 0
BYES 0 N
Permitted as: prwt
Under Section: � t' —�•
Supplementary regulations section:
Parking formula:
(1400 n4
Required spaces:
❑ YES ❑ NO �(
Items to be verified in the field:
Inspector : Date:
Notes:
sdP 1,�Cio -a4
Proffers:
❑ YES
If so, List:
SP's:
❑ YES NO
If so, List:
511106 Page 3 of 3
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