HomeMy WebLinkAboutCLE200600238 Legacy Document 2014-10-03Application for ,
Zoning Clearance -r-ea c -.�
OFFICE'USE ONLY
Ci4oning Clearance = 835 CLE # °- e >
PLEASE REVIEW ALL 3 SHEETS Check # q46!4 _ Date: — Z ZZ — to
Receipt # staff.
PARCEL WFORMATION
Tax Map and .Parcel: 40 1A Existing Zonin
Parcel Owner: C AJ�U `. L �r -� Ct 51t �� C-�Vl c
Parcel Address: Io-C),5 ru Park City - r p1 d04ts ✓ State i 1'`�'` 7 ip
(include suite or floor)
PRIMARY CONTACT r
Who should we calUwrite concerning this project? l' S
Address (;2 O S PA r ic- �o � City 1,�1G1r� a QS ✓,(/� State _ i G�i i y� 'dam Z ApGZZ� i
Office Phone: ) 1 t — D qbO Cell # Fax # ��' i3�3 l -mail
APPLICANT INFORMATION v '
Business Name/Type:
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces Al id any
additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. if you change, intensity or -move the use to a. new location, a new Zoninl,
Clearance will be required.
1 hereby certify that I o r have the owner's permission to use the space indicated on this application. I also certify that the informal ion providetl
is true and accurate to a cst of m ow edge. I have read the conditions of approval, and I understand` them, and that 1 will abide b: , them.
Signature Printed `--+
Mical 'AL INFORMATION
ed as proposed ( ] Approved with conditions ( ] Denied
w prevention device and/or current test data. needed for this site. Contact ACSA, 977 -4511, xl 19.
site inspection has been done for this clearance. Therefore, it is not a determination of compliance with he existin&
site plait.
[ ]
This site #;nplies with the, site plap. q of this dAte. n
Building Official Aate S J
Zoning Official Date (� r
Other Official AAJI, AIa Y" Date �l b
ll . /411141Anii Pa Da ,e p ---- ?/f'1LGf ky� d ✓t
rv� tdunty of Albemadrle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4121 i
511106 P ige 2 of 3
SYSTEMS &RESOURCES
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 ❑ 1v0
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 public water?
If private well, provid Hea t artment form.
Zoning review can n t begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
is parcel on septic or ie sewer?
❑ YES (� 0
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 #
%ning Tech to complete the following:
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
X1004
YES ❑ N
Permitted as: -
Under Section:
Supplementary regulations s ction:
V
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector: Date
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
$/1106 P tge 3 of 3