HomeMy WebLinkAboutCLE200600231 Legacy Document 2014-10-03Application
Zoning Clearance
OFFICE USE ONLY
RrZoning Clearance = $35 CLE # z do (P
PLEASE REVIEW ALL 3 SHEETS Check # Jo Date: !Q~O
Receipt # Staff:
PARCEL INFORMATION
or .uf�r
��w
Tax Map and Parcel: ' I lI 55, P,+a6e:� L t'd (a Existing Zoning P-2.,
Parcel
Parcel Address: `J �7 _. 6-M &m,S 41cw, RA city - (ro ' State W7 Zip
(include suite or floor)'
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 5� 1 P_%M A4 6AR /2DL*' City ('��L,'j` State AIA- Zi p
T
Office Phone: &3q) J`!) -_ 3 - AX-7 qCell # � x# q 3V X73 �j7LyE -mail
APPLICANT INFORMATION
Business Name/Type: 23 #Z0CK(- -rr �(W1) P LI X ,
Previous Business on this site & VA -AID &4 &n f2L- jOIZ104iS,
Describe the proposed business, including use, number of employees, number of shift , available parking spaces and any
additional information that you can provide: cv��
*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 use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ _ � A&,L Printed ':r" Yft 8"r K6��T
APPROVAL INFORMATION
[✓]Approved as proposed [ ] Approved with conditions [ ] Denied
[�] kflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[�] �To 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
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) 9724126
511106 Page 2 of 3
Intake to complete the following:
❑ YES [T'NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES Lod N'O
If so, give applicant a Certified
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 92O
Is parcel on private well or public water?
If private well, provide Hea- Mepartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
['YES ❑ NO
Is parcel on septic or public sewer?
❑ YES [IINO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES [l"NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoninz Tech to complete the following:
Reviewer to complete the following:
Square footage of Use:
AYES ❑ N
Permitted as: ru, G1.Se,
Under Section:
Supplementary re ul do s section:
Parking fop4 Ql x in �\
t, l 4 1
Required spaces:
❑ YES W NO
Items to be verified in the field:
Violations:
❑ YES IVI NO
If so, List:
Proffers:
❑ YES EJINO
If so, List:
Variance:
❑ YES [2 NO
If so, List:
SP's:
❑ YES M NO
If so, List:
$/1/06 Page 3 of 3