HomeMy WebLinkAboutCLE200600198 Legacy Document 2014-10-03U-2
1p�a�
Application for
Zoning Clearance
Al,
Zoning Clearance = $35
OFFICE USE ONLY
CLE # Z ® O (6 —
PLEASE REVIEW ALL 3 SHEETS
Check # 9q Date: F - / -O
Receipt # /S/j?Q Staff: hf
PARCEL INFORMATION
/+
Tax Map and Parcel: I ��'3 Existing Zoning `' V'4' -�G �--�V
+, r
Parcel Owner: f. 4,l
Parcel Address: f V( p OO 5, City (-u'&C10+CSat [ I,9 State Zip 0 Iqb 3
(include sui a or floor)
PRIMARY CONTACT pp
Who should we call /write concerning this project? Gr-e:IZ,2 , cJC�B1 Q -SGII�
Address : 0�a 4to _ In u t iz City (!k10.r 1b ffe 5 Vt 1 /PState i�a Zip A2 ft3
Office Phone: (�) 029_ 3675'Cell # Fax E -mail j &t11Q54k, cZb,M
APPLICANT INFORMATION
Business Name /Type: rhr6- ` ,+
3, C_f.
A- Business on this site Uy �1�i- �1.,[3T'n+r)r -L b ✓A- 77-12-EP+D s
bb
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: tee_ _ dl �6 fn I' -.5,A-V12 - l9�jX,411 10 .-5"
Mon - S &r d j2eL,K t_",5 O-A 3 sus a- 60 r t i mc.
*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 , IaL.I�� ' Printed G, -,*f,_0 , JC-rLQ_,-d�
AP OVAL INFORMATION
[ tackflow pproved as proposed [ ] Approved with conditions [ ] Denied
[ prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ O/No physical site inspection has been done for this clearance. Therefore, it is not a determ' einl- Aiane&- with-t
site plan. Backilow Device and/or
[ ] This site complies with the site plan as of this date. Current Test Data Needed,
Notes: SA 9774511, x 119
Building Official Date
Zoning Official Date t 131 I
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
IN
n
Intake to complete the following:
❑ YES ❑�O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 0-xO
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 DATES
❑ YES 5D11Q0
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
P- ES ❑ NO
Is parcel on septic or p lic sewer?
❑ YES 9Nv
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES -111
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
"Tech to complete the following:
Violations:
YES ❑ NO
If so, List:
k'ance:
YES ❑ NO
If so�L'st; � g - v
� rM -,
Reviewer to complete the following:
7 YEfootage of Use: S ❑ NO
�Permitted as: GAA
Under Section: d` a. 1
Supplementary regulations section: I
t
Parking formula: n
i 6 0x 0 —5
Required spaces:
i
❑ YES a NO
Items to be verified in the field:
Inspector :
Notes:
Proffers:
❑ YES 2 NO
If so, List:
SP'
FYES ❑ NO
X79' -"
Date: _
5D P (q �? q— (-7 xv 1 4 -% M -19' 5/1/06 Page 3 of 3