HomeMy WebLinkAboutCLE200700302 Legacy Document 2014-05-16., , ,
Application for050,e,14
Zoning Clearance el
OFFICE USE ONLY I'
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: ° -
Receipt # &VIS Staff.
PARCEL INFORMATION
Tax Map and Parcel: TM 5 D t I� 2 3 y� �✓ Existing Zoning CL _1
Parcel Owner: —Q V F' ,4 c- i ti n� �� �% �� �> Pig c L%j v0 G+ 4(o du ` r
Parcel Address: 2 5 �! 7 l� �� City C�V L� State
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? GAA Y �--'
\ I
Address: EQ, bOx City C y ��"� -,e- State Zip ,22 -0c,
434
Office Phone: (!tMbf X -q ° .)32t Cell # Fax # 9%- 4 - D. W -mail ��L3 W c' \I ac 1 h'(& , F-0
APPLICANT INFORMATION r
Business Name/Type: A W Oct-o (a Cj ii U L Fck't c��+ -�� L ` 1 J PLC—
Previous
� i
Business on this site JA
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: Ftzo v jke'56, & ta.:oct u e) t- ft-Use—L3., W tl In uIJ e.
L. f,+ i3 T E C iN 6 f--� 0 PEW t4-- ev t (OLA 1-S o-C
?041 *V-- t f.rb- is o a- S e -c F—
*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 kn wledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
r Z
Signature Printed
Backilow Device and/or
APROVAL INFORMATION Current est Data [ Approved as proposed [ ] Approved with conditionsonll Needs
[ ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977- A►���'4S11, g jj
[ ]JJ No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance wit t e e
site plan.
[ ]This site com�pplies with the site plan as of this te. 1 ,✓ A '� ,� p �Q ,l � •�`
Notes: Gf/y`- �it�(' Ul/d4 IN t U fit' 1( -A, Gt
Building Official c Date i ot v"
Zoning Official Date
LV it
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 dNO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES R"'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 ❑ NO
Is parcel on private well o ublic Ovate
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic o public sewer?
❑ YES &NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
FZ YES ❑ NO
Will there be any new construction or renovations?
If so, t ' e pro er P i .
Permi /
Zoning Tech to complete the followin
Reviewer to complete the following:
Square footage of Use: S
❑ YES ❑ NO (�
Permitted as: �C�Lk/0
Under Section: 2 d . ( 6 l
Supplementary regylations section:
(a I a
Parking formula: ( /&b, (0 W(A
Required spaces: I j
lJ �_
U YES U qqO
Items to be verified in th6 field:
Inspector:
Notes:
Date:
Violations: Prof rs:
F-1 YES NO YES NO
If so, List: If so,
Variance: SP's:
❑ YES INO ❑ YES 7 NO
If so, List: If so, List:
511106 Page 3 of 3