HomeMy WebLinkAboutCLE200600216 Legacy Document 2014-10-03l�
Application for
Zoning Clearance
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El Zoning Clearance = $35
PLEASE REVIEW
OFFICE USY, ONLY
CLE # o - Q Lo
Check #
ALL 3 SHEETS
Date:
Receipt # 1.UM Staff: t —
PARCEL INFORMATION
Tax Map and Parcel: �Q '- ' ��^� Existing Zoning 0-C)
C7 ✓�-�( � Pto 0 1 LL-L Jr,l
Parcel Owner:
Parcel Address:—/ Y2 e���`a�� City- l✓Y�'o Lb�i�LC�C State Zip 9
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? /rf//c %,J 9' We->"C C/ T_
Address : _;,� f ;?� City C ik/// L 'e State Zip
Office Phone: Cell # 4��� 2-7 Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: Xe .,-- . 1>"el-2,��'J ✓1f����-
Previous Business on this site %,(/ aG✓' w�/lr �'�G
Describe the proposed business, including use, number of employees, number of shifts, available parkin spaces and a y
additional information that Alyr >
you can provide: ,-,P L j y ew 2 - J' e ,� /✓� - �y'
4� e kt r,
*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 a space indicated on this application. I also certify that the information provided
is true and accurate to the best of ledge. ve r doe conditions of approval,, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
IVApproved as proposed [ ] Approved with conditions [ ] Denied
[ V]'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 _ f F a
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
511106 Page 2 of 3
a
t
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES NO
Will there Aebod 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 '►/
If private well, provide H t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO t�
Is parcel on septic or p he se e .
YES ❑ NO
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES} NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Gonmg I em to complete the fonowin
Violations:
❑ YES FVNO
If so, List:
Variance:
❑ YES WNO
If so, List:
Reviewer to complete the following: fj f j
Square footage of Use:
[YES ❑ N
Permitted as: al
Under Section: e1c
Supplementary regulations section:
Parking formu` a VaOO V�t'U
Required spaces: � l
❑ YES [jZ NO
Itergs to be verified in the fiel�dd:., A
Y i � V .1'I G� '��1. ✓/C..r
e a h rc
GWe Gc.
Inspector : Date:
Notes:
Proffers:
❑ YES Ea"'NO
If so, List:
1�SP s: YES ❑ NO
If so, List: I,
SPtkctq- 57 �it6iN �Wkoo
511106 Page 3 of 3