HomeMy WebLinkAboutCLE200600219 Legacy Document 2014-10-03Application for
Zoning Clearance
�y OE AL
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # (✓ 'cDCCLp - Q .
PLEASE REVIEW ALL 3 SHEETS
Check # Qnn Date: • 6
Receipt # to °710 Staff:
PARCEL INFORMATION
Tax Map and Parcel: d007 o Existing Zoning I✓
Parcel Owner:
/
Parcel Address: 1� City State _ Zi
floor)
(include suite or
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: City State va- Zip a2`?02
Office Phone: WD 'M -7) 5' t Cell # 1%eO"OI A Fax E -mail
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APPLICANT INFORMATION
.
Business Name /Type: _ PIT V ts; °4 Ri 2, a _ -% rnC,. �j7 Jpe•,:.�os ? e ZZ<_
`'
Previous Business on this site �+z) tl)r_
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: ?e22c_ ,J1al,.y�r�, Sl•,ar e a o� • 6S-o?p
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify ormove the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own W44ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true an urat o y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Seok�
APPROVAL INFORMATIO
r I ^ Approved as proposed [ ] Approved with conditions [ ] Denied
]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 C d S- t a
/
Zoning Official .� /( %� / Date 1/ �� ? ` V
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.
BYES ❑ NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can n t be in til we receive approval from
Dept. FAX DATE -1 t #,''
11 ❑ YES ❑ NO
Is parcel on private well o ublic� ter?
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 public sewer
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
;ryiES ❑ NO
Will there be any new construction or renovations?
If so, obtain ' ;!=
r P
Permit #�
GonmL l ecri to complete the iollowing:
Vi lations:
V YES ❑ NO
If so, I,,i�t:
Variance:
❑ YES Ej�-NO
If so, List:
Reviewer to complete the following:
Square footage of Use: I F) 0
JZ YES ❑ NO � "��
Permitted as:
Under Section:
a54, ; C l) �i� •�-. i �)
Supplementary regulatigns section:
Parking form 1
13 � 1 D�l'�
Required spaces:
❑ YES ❑ NO
Items to be verified i the field:
Inspector :
Date:
i V
961P M10 Mm,
Pro rs:
YES ❑ NO
If so, L�ist•'^n a A Q
SP's
EVIYES O
If so, List:
SP 400L (1 -41 /2 � P�
5/1/06 Page 3 of 3