HomeMy WebLinkAboutCLE200700247 Legacy Document 2014-04-28Application for
Zoning Clearance
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # a 6620 7 a"f
PLEASE REVIEW ALL 3 SHEETS Check # �14d�j Date:
Receipt # (, Staff:
PARCEL INFORMATION
I .1-t�
Tax Map and Parcel: 0 I .p— (� 17 t�(�— i o2- Existing Zoning P D G
Parcel Owner: ✓ o m b or to r1 L l m l"r tq P 4 r fr1 t r Sir+ p
Parcel Address: "-tea ' y 0 8 N l b c M arl e S� d vre City Ch 6 r(to +feS v, 11-C State V l r C 1 n i c, Zip za i O 1
include suite or floor)
PRIMARY CONTACT nn
Who should we call/write concerning this project? D o V l S C i a r k 1 •e-
Address : 1 2 3 o e J -{ r1S b 1 y City Char (o jt,- s v, 1-# State 1!+ r G n i G Zip2 2 0 i
Office Phone: (H 3i) 4141-9890 Cell # ? $ 1, Za ip ! Fax # 9714- 9 $ Q 9 E-mail-L) dive M @ G C 4 f, . C a n
APPLICANT INFORMATION I nn
Business Name/Type: A (n� We l I n c$ S M D -(P Q +C Q G
Previous Business on this site A d m i n I S f f a fi I'd Y% V C C '(eel
Describe the proposed business, including use, number of employees, nu ber of shifts, available parking spaces and any
additional information that you can provide: WOA ro-rn o�.*�. c, cse {i +w� c9,�c. �� Ka.\ ox, Vna..u�r`
ctn. 5 . Mid 0 5 T5 c ,
*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.
ur�
Signature � J Printed D a U I '�-
1
AP�ROVAL INFORMATION
[ jj]�Approved as proposed [ ] Approved with conditions [ ] Denied
V] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 97 T "19 -.11 '"°� _'__....
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determine omp.iAhce** Wi'tial.thq&N*%n
site plan. t Data Needed
[1/1 This site complies with the site plan as of this date. i, ,'+ i" ; �, ?7'7_4511, x 11S
Notes:
Building Official �- Date t o r i;z:. f Q `7
i
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
511106 Page 2 of 3
Intake to complete the following:
❑ YES] NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES E] NO
If so, give applicant a Certified
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 "El 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
E YES ❑ NO
Is parcel on septic or public sewer?
'El YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
9 YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 62.00'7 O l g 1$ A C
mooning Tech to%omplete the followinLy:
Violations:
❑ YES
If so, List:
Q NO
Variance:
❑ YES
If so, List:
❑ NO
Reviewer to complete the )following:
Squar r footage of Use: -0� � 0
YES ❑ NO I
Permitted as: �� rat z►
Under Section:.
Supplementary regu14i9ps section:
Parking formula: l ✓,o
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES ZNO
If so, List:
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