HomeMy WebLinkAboutCLE200600154 Legacy Document 2014-08-13ti
Application for
Zoning Clearance
. A
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
OFFICE USE ON IL
❑ Zoning Clearance = $35
CLE CM
Check #$ V U Date: Ifl
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: _ JM
PARCEL INFORMATION
Tax Map and Parcel: Q(p t W o " 01- 6 A - C0760 Existing Zoning
Parcel Owner:
Parcel Address: 1 P l y • City tate V 4 Zi 00
fl � e *
.2�i�clurum- e, oC
PRIMARY CONTACT C
Who should we call /write concerning this project? l .`
C4W.�- ���
Address: &40 &4mou"CA City State Zip
Office Phone: L_) Cell # Fax # E -mail
APPLICANT INFORNA,TION
Business Name /Type: G{j1�(,t�l�C{ y"�(
Previous Business this
on site%��
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*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
APPROVAL INFORMATION
[\lJPproved as proposed [ ] Approved with conditions [ ] Denied
[vj 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 determination of compliance with the existing
site plan.
This site complies with the site pl as of this dale.
Notes:��� 11 �94�
Building Official Date 1( x° o c
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 D/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
❑ YES 0 NO
Is parcel on private well or Cublic water? If private well, provide Heepart nt 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 �ZNO
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# P2206& - 1560NC1
"V10 q --1.— 01
Gonm ' ech to complete the tol
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
� In of n
5/1/06 Page 3 of 3