HomeMy WebLinkAboutCLE200700296 Legacy Document 2014-05-06Application for
Zoning Clearance
OFFICE U$E ONJ,Y
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date;/
Receipt # , r
�'1_3 Staff: y/—r5
PARCEL INFORMATION
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Tax Map and Parcel: I ®0 0 r 00'_ 14(O ` ®Existing Zoning C
Parcel Owner: VV k � o S. P _ c V , 1ILU S` j f i4) 0J � b (:f 1, I TS
Parcel Address: i 1 '-s t pltti —b 6—, City 6 JA? (LL.t_ 1_fLSVJ'`'9tate l Zip
(include suite or floor)
PRIMARY CONTACT V
Who should we call/write tncerning this project? i t'
Address: o city
tY l
Office Phone: C � Cell y 1 I %)-- Fax #
APPLICANT INFORMATION
Business Name /Type:
;'16vk;-
State y'A Zip�—
E -mail �1 e l S i„i e i, „(C. .... S \,
I1�,
1
Previous Business on this site �I-�A-L U fA7e- & 1 -r” 1CAS
Describe the proposed business, including use, number of em loyees, number o s fftts, available parking spaces and any
additional information that you can provide:
,AAA( S i` Gi✓� � f �i`c+ iaae� .4 I�— f,)a�'t—,y �,-F 1� d,� e
*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 th I own or have the owner's p emission to use the space indicated on this application. I also certify that the information provided
is true an accurat'd to the brst of my knowl d . I have red the conditions of approval, and I understand them, and that I will abide by them.
Signature ►1(% ' 6, Printed o G �L Q Olt,) C. k
AP VAL INFO TION
[ pproved as proposed [ ]Approved with conditions Crioee and /or
ckflow prevention device and/or current test data needed for this site. Contact ACS 97VLAS 1 �1 eedeJ
o h sical site inspection has been done for this clearance. Therefore it is not a deter i�allor t'o *totnp tta ithrt�he�egisting
site plan. Contact A. �..........,
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date [,).-I —L 1 3-1
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
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Intake to complete the following:
❑ YES [r] NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [�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
0-YES NO
Is parcel on private well ubli
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES 2 NO
Is parcel on septic o ublic sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES P-1 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Tech to complete the
❑V YES ❑ NO
If so, List:
�M .ivy, -c110 C$ PM,
Variance:
❑ YES F0 NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
)i YES ❑ N
I
ermitted as: �� i
Under Section: cti� n; �/� //L I
Supplementary regul tions section:
GGv5
Parking formulo-�,, aiV L,O -4,
Required (il f
�✓ i
n ac
ERIC
Inspector :_
i'
1
Notes:
Proffers:
❑ YES
If so, List:
F711 NO
SP's:
❑ YES
If so, List:
0 NO
5/1/06 Page 3 of 3