HomeMy WebLinkAboutCLE200600215 Legacy Document 2014-10-03Application for
Zoning Clearance
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[g] oning Clearance = $35
OFFICE USE ONLY
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check# Date: _�-% -0(/
Receipt # Staff:
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PARCEL INFORMATION
Tax Map and Parcel: —0-77& 1 °- 00 -00— 6 Cpl 66 Existing Zoning 12
Parcel Owner: ?J CI(,
Parcel Address: Sal C, 814Aa, C City Ca tK6JJ St1i11# State tIK Zip AMO-L
(include uite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? bwrA. DLay,
Address: Z2 6 ka J, orA L JCA' , Orj)e , city C-wlurssA t ¢., State VA Zip 22q3
Office Phone: 4( 3q q9-7 l(yy Cell #,(V `i$q 91q- Fax# E -mail )cwra o�
APPLICANT INFORMATION
Business Name /Type: NAenkaG A Ex.-,r,-;s a. CG
Previous Business on this site N /�
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: Wb�; le ( -,saro sso (0-/t, to :,,cl LA4 44�o 1- okwvws W-S Ll�{ s
,
Q ��Q,eK . ?ark;► ,ko skc-a & 0,,; -4L ?ya,
*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 I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed /�}.O r _�P ( v--
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[,,J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[;fNo 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 °f i cc,
Zoning Official Date -t l i0 L
Other Official _ ems. a ,,tjd 4 <a?2b''Vat_r Date 67 1 &p
4 �
C ounty 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:
F-1 YES LINO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
AYES ❑ NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be in u til we re ive approval from Health
Dept. FAX DATE D Cv
O
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
Is parcel on septic o ublic sew r
❑ YES ;J440
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES [j2/NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Gonme l ecii to complete the followin
Violations:
❑ YES (Z'NO
If so, List:
Variance:
❑ YES NO
If so, List:
Reviewer to complete the following:
Square footage of Use: -byD C
[YES ❑ NO
Permitted as:
Under Section: (?j . �� �i ��`tl
G LtIMA TA Aln',O
atiQnJ section:
Parking
V
Requir d paces• UC�
❑ YES 0
Items to be verified in the field:
Inspector
l�: Date:
Notes: 'T � ,f
Proffers:
❑ YES [94NO
If so, List:
SP's:
❑ YES [R/NO
If so, List:
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