HomeMy WebLinkAboutCLE200700286 Legacy Document 2014-05-06Application for
Zoning Clearance
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OFFICE USE ON! �
04oning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # 3 Date: 11-1q-0 7.
Receipt # %, / [ j Staff:
PARCEL INFORMATION
Tax Map and Parcel: 010 106 - Co -- bb — 6Q, ' Existing Zoning
Parcel Owner: fj. m
ftva 4. T, U C,�MS ��� Cavr) Qo. 8ox 355 Nov�G C r•l<v.,VA 22g5q
ParcelAddress:259 AgAVAMI C, �1alge- 1�0*-k) S" "City Cho'vl° SV,b1e
- (include suite or floor)
State VA
Zip ZZ40 I
PRIMARY CONTACT 'Mw k&W t. 1Nnevr L)-c, �„ -owr✓Y
Who should we call /write concerning this project? Jaf�reul 1
Address • ZS°I �v�,�xwv.JG� �ia1o�L �a+IiSu���t l4D City C nwl,4a4t)lo- State VA Zip 2Z°l01
Office Phone: (_� Cell #%434) gb2`2°t36 Fax #(86b) 933-4869- E -mail 'GfE�tt�.n�mn�co� Sr��YL"innovrFt
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APPLICANT INFORMATION,s�,,,,,��w1,► v►•wti+}
Business Name/Type: Sr ► L LC, Go�►s+ % Gar'h' ^� Y
Previous Business on this
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: USa : 5
*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 %5
APPROV INFORMATION
IVY, pppoved as proposed [ ] Approved with conditions $��eviee and /or
[�Backflow prevention device and/or current test data needed for this site. Contact ACSA, 97 -45 1, est D to Needed
[�J No physical site inspection has been done for this clearance. Therefore, it is not a determin i . A cAe �t etet'ktiiw
site plan.
[ ] This site complies with the site plan as of this date.
Building Official Date i ( f �—k I -1
Zoning Official Date
Other Official Date
County of Albemarle Department of Uommuntty lievelopment
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 2/NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES M'-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 0�i O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ��NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the following:
Reviewer to complete the following:
Square footage of Use: n7� n
El Y d as� Q
Under Section:v ,IY! 4
Supplem i nthiry regulations section:
Parking formul, T G A-PA
Required spaces:
❑ YES ❑i - NO
Items to be verified in the field:
Inspector
Date:
Violations:
(✓/ YES ❑ NO
Ifs List:
/ '' �Z C�"� u1/G� �' �9✓�L
Proffers:
❑ YES
If so, List:
IifNO
Co
1 V
QA
Variance:
❑ YES
If so, List:
1[]' NO
SP's• /
❑i /YES
I so, ist:
�] NO
l
y
511106 Page 3 of 3