HomeMy WebLinkAboutCLE200600206 Legacy Document 2014-10-03Application for
Zoning Clearance
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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 ONLY
Zoning Clearance = $35
CLE #r
PLEASE REVIEW ALL 3 SHEETS
Check # Date: 16 la I TUE2
Receipt # (pj Staff:
PARCEL INFORMATION
Tax Map and Parcel: 61-1-31 Existing Zoning rp , C J C
Parcel Owner: L i'N V\h,-+'f!�
Parcel Address: 12� U (Lo c d City NUYIOki -eSV -t) Ie State V Zip 2.Z 4 6/
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address:-);?,-) kA c-v S cam-• f o v A' city 'u" t k State V Zip ZZ qL"
Office Phone: q) 9 � T- _ Z91 f Cell # 151 24Z-90(DZ Fax # E -mail _ ► Luc' %/ct ce-n-,
APPLICANT INFORMATION l tI
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Business Name /Type: (!i aL
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: �-�-r tL,, cQ y ets�. Vt w l -th C-� .._ PVI l u y e C
A UJU i�tr� �l we GI..vCt l,X Ci tl-Q-P
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 I have read the conditions of approval, and I understand them, and that I will abide by them.
9knowledge.
Signature Printed L t n cl S `` `J e, S
APOV M
FORATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[VN o 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 plan as of this date.
Notes:
Building Official Date , r
Zoning Official Date
T
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 Q NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES dNO
If so, give applicant a Certified
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 N3/'NO
Is parcel on private well public ater?
If private well, provid epartment form.
Zoning review can no begin until we receive approval from Health
Dept. FAX DATE
[;YES ❑ NO
Is parcel on septic or is s er?
❑ YES [�N
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 #
Coning 'Tech to c
Violations:
F-1 YES RNO
If so, List:
Variance:
❑ YES VrNO
If so, List:
the
Reviewer to complete the following:
Square footage of Use: 'jJ ►ro k isz 0
YES ❑ NO � 44,1-1t _ r
Permitted as: GG�
Under Section: A- �- 2-(p L
Supplementary regulations Section:
Parking formula:
1li0U
Required spaces:
❑ YES U NO
Items to be verified in the field:
Inspector : Date:
Proffers:
❑ YES [�NO
If so, List:
SP's:
❑ YES NO
If so, List:
� 1 1
Mr
5/1/06 Page 3 of 3