HomeMy WebLinkAboutCLE200600200 Legacy Document 2014-10-03� a
Application for
Zoning Clearance
=�pF AL@,�,,'
Qo a dL,-+
�-
Phu
0 Q cell PhU r t
County of Albemarle Department of Community Development
401 McIntire Road Ch 07; ille, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 .
� 5Z64/06 P ge 2 of 3
OFFICE USE ONLY
Zoning Clearance = $35
CLE # ( —7-06
PLEASE REVIEW ALL 3 SHEETS
Check # /
Receipt # Staff: beg
PARCEL INFORMATION
Tax Map and Parcel: ID [p LOC6 — �d - 9'0G Existing Zoning_P wy Co -�
Parcel Owner:
q
Parcel Address: �L Z [� 1 V" �I �(� City Xy!Y j State (/C( -,, Zip
(include suite or floor)
LX) Q,0L;t 0' nGL S JNzraxs l,A ps
PRIMARY CONTACT II,-,
Who /write S khV\Oo
should we call concerning this project?
Address: City 0 State Zip Jr�
Office Phone: �r]- Cell #` �' I Fax # E- mail (° 0,r 1 g5Sct6{ i? 0
APPLICANT INFORMATIONCl
Business Name /Type: c�iCLVIhhh ou+,
Previous Business on this site Lt 1C 6) /y t VLO.9 , a 13 Q7/,-- W-Z u /n Cl JCL _
Describe the proposed business, including use, number of employees, number of shifts, available parking s aces and any
additional information that you can pro ide:
^
'
SW I L �.S L�� �1��Q�
c1 47 � Gl'1 J S
,
�1 �cLC
�"
N oW as I & I oiO i Ka (uu; i 11 �sl �` L' v' i L at 4 VAX i� 1 _�tN i V1 � `ii WA t; v � no(
� � al c�cl,vtk is CID seal _ Sea.w fto 6&te et a,,w"1 50 -70 S!r v
*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 C �� ' L Printed Skqa, itu A 0 6W. —
APPROVAL INFORMATION
[ ] Approved as proposed [1,<Approved with conditions [ ] Denied
[ ackflow 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 pla}? of this date.
Notes: A94 A GtAE_ A&W _
Building Official Date �,_F 0 C.
Zoning Official Date LA � n G
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Ch 07; ille, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 .
� 5Z64/06 P ge 2 of 3
Intake to ;NO ple �e following:
❑ YES
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 2- 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 O
Is parcel on private well ublic water? L.
If private well, provide He t foi
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
ES ( /
❑ NO �► V.I Iq
Is parcel on septic o rruvi s sewe
❑ YES [ O I'
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES Lw U
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ech to complete the fo
EVES ❑ NO
If so. List:
Var' nce:
YES ❑ NO .
If so, jst: 'A 00 ` t
Reviewer to complete the following:
Square footage of Use: ANO
VYES ❑ NO
Permitted as:
Under Section: U• A�� �di
Supplementary regulation section:
Parking fo1 y -04 _/ +
Required spaces:
❑ YES 0 NO
Items to be verified in the field:
Inspector :
Notes • ,l d .*4 .5 .
Proffers: //
[I YES (�/NO
If so, List:
V SP' .
YES ❑ NO
If s4, Pist ' -7
Date:
'd X r3o CGS a.Gos- a� t� cue
5/1/06 Page 3 of 3