HomeMy WebLinkAboutCLE200600207 Legacy Document 2014-10-03�I
Application for
Zoning Clearance
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OFFICE USE ONLY QL� ��^ - j
❑Zoning Clearance = $35 CLE # p�,�p
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff: , _ 4 fl
PARCEL INFORMATION
Tax Map and Parcel:
Existing Zoning PIA PC>. n!V
Parcel Owner. 1
n CParcel Address: � City � State _Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ! J e f V) )(f
, Ill
Address : 00 hPi
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�i 3 City C�nci��a�� �,i, �� G_
State _ V4- Zip Z2°1' ( I
Office Phone: 4 3
q may- N3� Cell #
Fax #
E -mail
APPLICANT INFORMATION n I 1 _
Business Name /Type: I VGA SoK % `LIckey -, PI•C A*—o(yi u S a, ' Lauj
Previous Business. on this s
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: -90, 4- 1, .1:2•
- F_:�'. rb n--.
*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 knowled e read the conditions of approval, and I understand them, and that I will abide by them. I
Signature Printed )4-Li S(a N &ISoyk OA ex, kr Ne 15ovt *TU dw/
APPROVAL INFORMATION PLC
[►/] Approved as proposed [ ] Approved with conditions [ ] Denied
[ V] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ V�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 t e site plan as_ of this date. -
Notes: _ E� �OYI�-� JZ, (�Kd'
Building Official KPIA 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
iE
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [ '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 ['NO
Is parcel on private well ublic Ovate
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 septi r ublic sewer?
❑ YES ❑ NO
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, obt
Permit #
Conine Tech to complete the rollowin
Violations:
❑ YES V NO
If so, List:
Ig
Variance:
❑ YES R'NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 1466,-,
�ES ❑ NO -
Permitted as: % S
Under Section: ?✓ rZ
Supplementary regulatipnp section:
Parking formuJa: / 0a
Required spaces:
YES ❑ NO
Items t b�ver' ed in the_field:
Inspector
Date:
Notes: Fat& "BAP fj8 - 3l (• -
Pr ffers:
YES ❑ NO
If so, List:
SP's �,�
YES [NO/
If so, List: ✓ / / r,6 n
511106 Page 3 of 3