HomeMy WebLinkAboutCLE200600223 Legacy Document 2014-10-03Application for OF Al,
Zoning Clearance � IRG[N1P
❑ Zoning Clearance = $35
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: i
Receipt # Staff:
PARCEL INFORMATION
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Parcel: ��� �rac� CSI) 1�2dur r 061&0-00-cm
Tax Map FP--
and Existing Zoning
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♦�rc �JS'�taCt j— r/ /"?4'-�'4eilrAi E a dJiain�i�✓ o.. iYb eaY�. -c.— J.,C
Parcel Owner: P I�YCi�,+nq d! X 717-°
Ba ev, i�A 7,2-9o4-
Parcel Address: SS Alb,em,.,wJe ��" ''� ;�'/ ; City / � / °'�'u1�� State Zi p
(include suite or floor
PRIMARY CONTACT
����� Nit/'M�tnq
Who should we call /write concerning this project?
Address : 15'D¢7 WeJ4-,Dv1W ��'� �I �rc� City A CAA,-nd State Via Zip 13 ,'-.r
Office Phone: L� Cell # �� �3" G,S�o Fax # E -mail _�e�1t'"°'�'� (9 tf'llia °� c om
----- e /ld P /e�,sr Ca /9 €�✓ o
APPLICANT INFORMATION j ten i :l t
4'e/'� ' LLC S-d1,4e
Business Name /Type: �o� e7
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: rCh -A.e• o-tr fyelA"A , B_24i'MMI 19(U ° Cbr.+,,,,,;It 4y
mg.w;3 i-r "a .ham ,e^e, Ply► Y 1A rh1' -eV ., 43yos 6 8 a #tier 4_4c , I -*#,ci 05"1 0 -2-,S tte+et/
Whot'e.tak A'er, .2,,(q;xr, ''-3 -4 s2�rp /a9erC�' pfreti _-4!N,,e1Wk — 40-go k1ra -t vi¢
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*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 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 t P the best of knowl av e read the conditions of approval, and I understand them, and that I will abide by them.
Signature �" �dl� �' Printed /> i)x- t i.1 • M V /entity
/�Drrlc: BuBr�es� sellYia� tY Ca�a�drns��ri� inrlli+ dlusr�e✓ - ! 'as�2yl+i aAd
AP ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
X
[o 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 -t a C
Zoning Official Date I I b Po
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
`1
t:
Intake to complete the following:
❑ YES 4 NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES dNO
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 well ublic water
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
3(YES ❑ NO
Is parcel on septi r ublic sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 5d NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning Tech to complete the
Vio ations:
TT YES ❑ NO
If so, Lap
�J
Va • nce:
[YES ❑ NO
If so, is
1
Reviewer to complete the following:
Square footage of Use: P500
ES ❑ NO _
Permitted as: erJ +
1
Under Section: C72/.) z
Supplementary regulati ns section:
Parking formula:
l/1ao
Required spaces: !�
❑ YES ❑ NO
Items to be verified in the field:
Inspector Date: l /
Note
ME
— �X- •i.u.: i it ' [� ,, � ' .��, a'/ �
Proffers:
❑ YES
Ifs`La,t•
[Q-NO
SP's:
/n"YES
If so, List:
❑ NO
5/1/06 Page 3 of 3