HomeMy WebLinkAboutCLE200600188 Legacy Document 2014-09-29Application for
Zoning Clearance
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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OFFICE USE ONL,C p
Zoning Clearance = $35
CLE #�� -- /
Check # 02(o 3 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 6/ 1 CI % Staff:
PARCEL INFORMATION
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'— � ' Existing Zoning s ponnc ✓
Tax Map and Parcel: 00 l /%�(� "� 00 '-
Parcel Owner: � 9 U ro MCyL VL►i.S�.�C . C
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Parcel Address: %l q t bSaJw-, tl eina�L City C�a�►�o��SJ•��f State VA Zips 0%
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PRIMARY CONTACT p
Who should we call/write concerning this project? L�-C-
Address : L� 0 '�AS - PA At+ Sjnifk 911 .1 City QA �-�: P OA i State V4A-4Ay 1 A-0 Zip Z20 a
Office Phone: 10 0? 30 -000 1 Cell # Fax #1410 230 -OaC 1 E -mail �� ilpat�Cn�JfiC� -��iT� rAn
APPLICANT INFORMATION
Business Name /Type: Cb\JSA:� VA'1^9 .. PAA 11114 . U4 T% A # 40- AA6a C %- No4.1 VVAA4 C.V%S AGE -+u.
Previous Business on this site A WAS -AA65 eAA-e Of SlAS- 141..DVA0
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
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additional information that you can provide: Row*, 14-&W.
*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 know dge. I have read the conditions of approval, and I understa'n'd them, and that I will abide by them.
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Signature Printed DA O
APPROVAL INFORMATION
Nef,Approved as proposed [ ] Approved with conditions [ ] Denied
[ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[LM physical site inspection has been done for this clearance. Therefore, it is not a determinat rnpk th the existing
site plan. Backfl0 Device and /or
[ ] This site complies with the site plan as of this date. current Vest Data Needed
Notes: ,.
Building Official Date
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 fK NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. c a-
❑ YES 5� 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 �2 NO
Is parcel on private well or public water?
If private well, provide Healt apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
2�YES ❑ NO
Is parcel on septic or public wer?
X YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES g NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1.0ning Tech to complete the following:
Violations:
1-1 YES NO /
If so, List: 2
Variance:
❑ YES NO
If so, List:
(y�13- Vii%
Reviewer to complete the folloowing,:,�, ^ � x � � O
Square footage of Use: —SL-)— t 1 +(MA
❑V ' YES ❑ NO
Permitted as: n ji(kX
Under Section: d' �' A - 0t A 3,a-1-6
Supplementary regulations ct* n:
Parkin f Z formula. �p 0
Required spaces: 4
❑ ;YES ❑ NO
Items to be verified in the field:
Inspector :
Notes: ag- ;too J--
Ia
t ;OUT - 5-4-361
Proffers:
❑ YES
If so, List:
SP's:
❑ YES V<O
If so, List:
apt.
Date:
5/1/06 Page 3 of 3