HomeMy WebLinkAboutCLE200600214 Legacy Document 2014-10-03Application for
Zoning Clearance
=�oF ALgc,,v'�
U 51"'L'�r in
I'IRGINIP
9 oning Clearance = $35
OFFICE USE ONLY
CLE # `Z 0o (V — 2—
PLEASE REVIEW ALL 3 SHEETS
Check # 1 `1 Q Date: ._ (V
Receipt # ip f T 2!7 Staff: ! o
PARCEL INFORMATION
Tax Map and Parcel: O b % r)10 - 0d - ®6 " 0 0 3 ®(' Existing Zoning
Parcel Owner:
Parcel Address: ��I r� i �� City! 4e f /0 X-541//, State Zip
(include suite or floor)
PRIMARY CONTACT --�—'
Who should we call /write^ concerning this project?
Address: ) 1�U► City
. State tO Zip
Office Phone: C�J() C%0el - 5 0 Cell # e1?q (n7 Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: IA .� -G• i % t✓�te,,� t [ w� ,
Previous Business on this site
Describe the proposed business, including use, number o pl ees, number of shifts, available parking spaces and any
additional information that you can provide: rya r,a� � � / — �
�� •v`.vvWX
*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 ac ate to the best o y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature % Printed % ,-I La
APP RO INFORMATION
[ proved as proposed [ ] Approved with conditions [ ] Denied
[ ackflow 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 —t C.
I
Zoning Official Date Q J )0,/,
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
i
Intake to complete.,the following:
❑ YES 10
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [ZNO
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 0
Is parcel on private well or ublic water?
If private well, provide He form.
Zoning review can not begin it we receive approval from Health
Dept. F X1DATE
YES ❑ NO
Is parcel on "ATE
public sewer.
❑ YES 0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES Ly' O
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1'ecn to complete the followin
V1 YES ❑ NO
If so, L' t:
VTOcti006o — 10
Va fiance:
YES ❑ NO
If so) List:
Lqg- �r l
Reviewer to complete the following:
Square footage of Use: d
YES ❑ NO
Permitted as: o rr� Ik..
p F
Under Section: � ;• � t ( W)
SupplemV �aK regulations section:
Parking formula: l /�Q (9 LOV
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector:
Date:
- � ' � , � �. X4'1. " •
Proffers:
❑ YES V NO
If so, List:
SP's:
❑ YES VzJINO
If so, List:
5/1/06 Page 3 of 3