HomeMy WebLinkAboutCLE200600218 Legacy Document 2014-10-03r
Application for
Zoning Clearance
Zoning Clearance = $35
PLEA E REVIEW ALL 3 SHEETS
OFFICE USE ONLY
CLE # Z-o®tp a
Clheck # @ Date: q— 7-010
Receipt # (Aj?i4'% Staff:
PARCEL INF RMATION ��
ou, -L-L Qs to G S @ 0 L' YC b
Tax Map and Parcel) �, I ro.3 r I l ZOLv �i(� Existing Zoning
($,r
Parcel Owner: 60:. A CLA-dL . G0opipY6 LLJQ"
Parcel Address:(jo[) T6eiJe U CityL %Wot',l e State Vg4-- Zipn j%
(include suite or floor)
PRIMA R'117 CONTACT j
Who should we call /write concerning this project? Qj Cd C
, n
Address: Mb Sty . � lq� . J'� �Z City State V Zipz* t
Office Phone: (3`t Cell ON W-3M- Fax# Y— E -mail �e(�t<`at,�'t,��'tiJ�e� •�0�
APPLICANT INFORMATION
Business Name /Type:��
/�C�
Previous Business on this site bjaQ
Describe the proposed business, including use, number of employees number of shifts, available parking sp4ces and any
additional information that you can provide: d o
(-0 s3.i�
*This Clearance will only be.valid on die 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. 1 also certify that the information provided
is true and accurate to th blest of my I: owledge. I ave read the conditions of approval, I understand the and that I abide by them.
,aand `m, will
Signature �/ Printed J�� � W 4 V ZOE
AP OVAL INF01Z IATION
[ proved as proposed [ ] Approved with conditions [ ] Denied
Backflow prevention device and /or current test data needed for this site. Contact ACSA, 111 -4511, x 19,
o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
tte plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date o
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5332 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 . 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 54 NO
Is parcel on private wel l or )ublic wate ?
If private well, provide Healt�ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
ED YES ❑ NO V v
Is parcel on septic or pu lic sewer.
❑ YES W 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 #
GonlnL l ech to complete the tonowln
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
.�,3
/ '� 0
ID
Reviewer to complete the following:
Square footage of Use: A a& C) 0 T
EX YES ❑ NO ���((' / �C
Permitted as: I- �r�;41a "" � � Ap t
Under Section: 955 D 1444.1 CL)
Supplementary regulRl iOl section:
I q
Parkin ;y o`� 6 — A ��� �o i� • g�
Required spaces:
❑ YES Y NO
Items to be verified in the field:
1 1 Z
Inspector: Date:
Notes:
5/1/06 Page 3 of 3