HomeMy WebLinkAboutCLE200600217 Legacy Document 2014-10-03Application for
Zoning Clearance
AL�9
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 # C L-e- "200( &a.11
PLEASE REVIEW ALL 3 SHEETS
Check # J Date: -0(0
Receipt # 4 Staff.
PARCEL INFORMATION
%%
Tax Map and Parcel: UJ " 3 - '11h I Existing Zoning C 0M roc, .r+
Parcel Owner: L,,u'DA '61.4 Ke 0.+y L
Parcel Address: /qZ/ CO)I►e''--+'Itt*ecce�K /3A < City erg Zi�>"Pt/i ✓iP State V- Zip
�� _J
(include suite or floor) V; I lT
I/
PRIMARY CONTACT
Who should we call /write concerning this project? 1F r
Address: 2�, -�' � �� City �" r 3�i /JP State �/� Zip Z2
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Office Phone: `y( ,��) v �r a�' �' Cell #30L'C'S^J2 7/ G Fax # PLO-0-a E -mail -Or Ry d Lam
K C r. awe a1<-#? .P .
APPLICANT INFORMATION
Business Name /Type: prD( :t J $ CC
1-7
Previous Previous Business on this site -
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: _ -� �� r`ct lri C 'L2 t;(.,_, 3,(- c�c`�' -,,c, �2 „c�C p�„Rn /c L4 e,- .r
y
i
*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 ow have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate the be of my knowled I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature' Printed r i. C- U,( ,
AP ROVAL INFORMATION
[ 14,Mproved as proposed [ ] Approved with conditions [ ] Denied
[ ckflow 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.
Note
twh o w
,71
Building Official �— Date o
Zoning Official Date 1L b
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:
YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [,M 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 well1z�i
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO _.__
Is parcel on septic o ublic sewer? V
❑ YES ❑ NO
Will 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 #
'Tech to complete the
Violations:
❑ YES NO
If so, List:
Varia ce:
4MS ❑ NO
If so, List:yA 1187-74f
Reviewer to complete the following:
Square footage of Use:
[IYES ❑ NO
Permitted as:
Under Section:
Supplementary regulationssqction:
Parking formula:
l8 ► �o� -(�F�6 z 7- 3
Required spaces:
❑ YES NO
Items to be verified in the field:
Inspector: Date:
WNW
MIM
Proffers:
❑ YES
If so, List:
[ I'NO
SP's:
❑ YES
If so, List:
N3-`N0
511106 Page 3 of 3