HomeMy WebLinkAboutCLE200800066 Legacy Document 2014-09-22r
Application for
Zoning Clearance
pt Al,U
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
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OFFICE USE ONLtk
El Zoning Clearance = $35
CLE # -
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
/��/� i /� (�
Tax Map and Parcel: !�' � �VV'- {� -W � �� Existing Zoning 1''� �
Parcel Owner:_\k566 —LL i -S Cwt t30e M \ LL612
Parcel Address: 663 ity C jkWL,�rt zylr' 6( L-r_• —State Zip '_'2a9C)t
(include suite or floor) Ott,
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: G)s IF, 2 T "� ���— City J:�J i j_ �= J, h (t� State F- ' , Zip
, °riv1 ICI L "
Office Phone: 3( 5a Cell # CG �v` oo� -mail �3iCi1 a
APPLICANT INFORMATION
Business Name /Type: 'SA)05kW\h °�J.i E 6- 1
Previous Business on this site :0 _01:7 °PAS I& IA S
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: bc—, , 1 BIA 5 i lJ �5S A-, C30 4
C�Pv\ L c�i_iC� 0 pe 5f t r (A m a,r„ - S oa !�h,,.
*Thus Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, a new Zoning
Clearance will be required.
I hereby certify tha ow or have rie o er's pennission to use the space indicated on this application. I also certify that the information provided
is true and accura to tl bet o my owledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature / Printed -P&Mg, t&4= �g'T
APPROVAL INFORMATION
[�f Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacl&ow 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 detei7nination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official �— Date
Zoning Official p 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
5/1/06 Page 2 of 3
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6!, z19
4
Intake to c mplete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 'Vf ❑ YES NO
Will there e 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 a lic water9
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 a lic S-ey—ir
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm!
Permit to
❑ 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: 1'71 5y
4 YES ❑ NO
Permitted as: llF .i��Q� by M,4r9 SA e j
Under Section: 'ZS�.� -�'
Supplementary regal horns sect�y
Parking formula:
/111
Required spaces:
❑ YES �Z NO
Items to be verified in the field:
Inspector : Date:
Violations:
❑ YES ONO
If so, List:
Proffers:
F1 YES NO
If so, List:
Variance:
❑ , Lis NO
If so, Lis .
SP's:
❑YES �NO
If so, List•/
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03/25/2008 09:48 FAX 434 817 1245 GRUBBULLIS REAL ESTATE 009
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