HomeMy WebLinkAboutCLE200600208 Legacy Document 2014-10-03Application for AL9�
Zoning Clearance
OFFICE USE ONLY
Zoning Clearance = $35 CLE # -Z O63 & 4 Z 0?
PLEASE REVIEW ALL 3 SHEETS Check# Date: $- 2 4¢_0 �p
Receipt # 614,1e) Staff- be Q
PARCEL INFORMATION
00-500-
Tax Map and Par I: Existing Zon g � Cam' ��
t ' y , t 4j Parcel Owner: "�i } 1 '�(� �S �A'e 1i P.i�q _i. e * "" - nr�e�u � tv�,yi �';� �; l Pte' Parcel Address: � � �. City �- � +��=- State VlVqtif1'�C -�.
4evii zip �(C�I
U �
(include suite or'floor) (+&' T W-Vle+ ,:-1,q.,!�� <Aed
PRIMARY CONTACT (�
Who should we call /write concerning this project? �;i�1�i� 'NAf)b \ \;,e zeA
Address : tl �+'GiS��.SICaC�re , City 4a� ���State �l�ft1k111 Zip l-�
�' ;.1 ,�
Office Phone: �i( ,,C)c'(7`("Ci Cellax# E- mail\ -1`itS��(t^,(}i,��,
APPLICANT INFORMATION
r
Business Name /Type: I �c i Jib t7 = I_,� . �M, "` Si "1il- Giy1l1!�i( 1 ���b S ct& IVIG
Previous Business on this site plr,ne;i—
Describe the proposed business, including useyrber of employees, number of shifts, available parking spaces a d any
additional information that you can provide: ,( �/l �, E��.) il)f��1'� 1�1( ?, „C- V( (��Z Y1 - (Xq��fliAfal
*This Clearance will onl be va(i on the parcel or Lehi' _Is approved. If you change, intensify or move the use £to,a'n�e�w location, a new Zoning eAr
Clearance will be required. �4)'� t; 'i��Lf C.- j (a - - CJ ®VrY1 �}VV')sa
I hereby certify that I own or have'the owner's-permission to use the space indicate
is application. I also c rt fy at the i information provided
is true and accurate to the best of my knowledge, have read the conditions of approval, and I understand them, and that I will abide by them.
Signature (. lG�J'i' i (.�.�% ,� Printed Ch VO�S� lltii'e'�!' �d �l1 Ll�ii
AP ,ROVAL INFORMATION
[VI Approved as proposed [ ] Approved with conditions [ ] Denied
[✓]'Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[V]'No physi site irl,spection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.�th [ ] This site complies the site plan as of this date. Backflow Device and /or
Notes: I i'nrMnf Tact n-4.. XT--,V-.X
Building Official Date l C�
Zoning Official Date g b (
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 E? /NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES EJ,1�0
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 or ublic water?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES ❑ NO
Is parcel on septic or ublic sewer
j�'Y_E�S I �NO
Y
be putting up a new sign of any kind? If so, obtain proper
Sign permit. -re- ryll P S
Permit # 7 �T - nG, '7'
❑ YES [TNO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
l ecn to COmDlete the
Violations:
❑ YES NO
If so, List:
V''
arance:
[YES ❑ NO
If so, List-
VA- 115
Reviewer to complete the following:
Square footage of Use: $4 00 n
YES ❑ NO
Permitted as: e w -
Under Section: Pk A, . A<,v n r`p V4,
Supplementary re tions section:
G 1 1100 r (.S 560
Parking formula: i /oleo _ ►' P�uc Et',w�
'504-1.5'
Required spaces: 4/,6-
❑ YES 0 NO
Items to be verified in the field:
Inspector: Date:
Notes: Cu,--a006
cif' s crtai .9!1 . Lu► „ k=j244 .
Proffers:
❑ YES &I/NO
If so, List:
SP's:
j�YES ❑ NO
If so, List:
�p� moo ► —a�
��a . � . a. c _� C.�siwrM,e►2� a ��
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