HomeMy WebLinkAboutCLE200600212 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
5/1/06 Page 2 of 3
OFFICE USE ONLY
❑ Zoning Clearance = $35
CLE # a—,k2n(p _ ,�;) 1 � ,
PLEASE REVIEW ALL 3 SHEETS
Check # 1co Date: .,?)/)
Receipt # f' nl M 9 Staff: SM .
PARCEL INFORMATION
Tax Map and Parcel: qb �`J Existing Zoning L --�-l�
Parcel Owner: 630b 15n CIO
Parcel Address: 1�3S3 AVdri St- E7c+- City State VAf Zip 9_99CR
(include suite or floor)
PRIMARY CONTACT ,
dr-e- ',Ne.. f -norr-i 5
Who should we call /write concerning this project?
Address: iOj 73 (vtii -) Sj- 6Y, +, City 0 `r�� 1 i<ff- State Zi P
Office Phone: tlY Iq 711-q7'70 Cell # ,E -mail
APPLICANT INFORMATION
Business Name /Type: L Wr e C- L c %r. ,
Previous Business on this sitelt
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: 4CLU1 r, r-t Z. vej., ;e Jes
I 0;!3e e, dn L-4+ 0"1,4
*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 p vided
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 b
Signature f!=� -° L� e Printed �SS� �+�
APPROVAL INFORMATION
O��e
[ ] Approved as proposed [ ] Approved with conditions Denier
[ ] 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 1=1 i �.st�
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
5/1/06 Page 2 of 3
Intake to complete the following: t IJ
'YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES c[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 o ublic water? ✓
If private well, provide Healt epa ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
YES F-1 NO
s parcel on septic or ublic sewer.
p YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. p /
Permit # 1,4evi
❑ YES 2.50
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
'Tech to complete the`followin
V YES F-1 NO
If s Do /
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 19 (50
❑ YES O
Permitted as:
Under Section:
Supplementary feulat ons section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector :
Date:
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
5/1/06 Page 3 of 3