HomeMy WebLinkAboutCLE200600210 Legacy Document 2014-10-03Application for
Zoning Clearance
AL.
`�RGINIP
oning Clearance = $35
OFFICE USE ONLY
CLE # Co — Z�
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: InE
PARCEL INFORMATION
Tax Tax Map and Parcel: (p 1P / r M �1 4 `•' 06 R D O Existing Zoning
(®—
e m 'e p L I— C
Parcel Owner: I� 1 Z
Parcel Address: g`T 0✓►City State Zip
(include suite or R floo r) _� -FI® OR
%`G
PRIMARY CONTACT
Who should we call /write concerning this project? e c— �Q\, -,+e—
Address: (�,3-i ec �livv�a �- C-rC,�e_ City Ck6l,rjo iie5U1J /e State V- rc, °,1,, °,GL_ Zip
Office Phone: LI3 -],)) Il -Cell # Cti3tl -7 Fax # N& q : 0 E -mail `� t r, }� , g� /r> 61- Q�l
APPLICANT INFORMATION
Business Name/Type: _} rn-� P�.�_ rov+la-4 �r� 5 �v,r < ��LtsSi��bS Eve-y& p lcchvle,'
Previous Business on this site Qry pe f+\/
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: 62 e= e- f 5 — WAl • Wve e 2
1, ICS - 44,PQM Movi - e m
[L r C
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify ormove 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 r Printed ) e-vw\ °J�e r l t) I +e
APPROV INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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 plan as of this date.
Notes:
Building Official Date lJ�
Zoning Official Date z•� ��v
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 �NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report ER) 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 X10
Is parcel on private well o ublic water?
If private well, provide H lth De pa t form.
Zoning review can not begin a receive approval from Health
Dept. FAX DATE
PYES :septic NO
Is parcel on public sewer. ❑ YES NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
GoninL 'Tech to complete the followin
Violations:
a YES ❑ NO
If so, List:
V10
Variance:
❑ YES [124NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
[YES ❑ NO
Permitted as:
Under Section: 4di 6
Supplementary regyI tipns section:
Parking formul
0 61 -ft x
Required spaces: ( � �
[I YES ❑ NO �"�.
Items to be verified in the field:
Inspector :
Date:
Proffers:
❑ YES [PINO
If so, List:
SP's:
❑ YES GY'NO
If so, List:
511106 Page 3 of 3