HomeMy WebLinkAboutCLE200600244 Legacy Document 2014-12-02Application for
Zoning Clearance
Q
❑ Zoning Clearance = $35
OFFICE
CLE #
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 6110 10 - (,4 - Existing Zoning � V✓ A
Parcel Owaneerr:_
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Parcel Add es : �✓ 11C�/ /l (jl 1� City [ / i/i �I� State V A Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? KJ49%R E1 J 1 �i L-1✓
Address: G 15 Wooa r69Z3CW-- V KAVE City C1 i"f a te VA- Zip 'A-2-'161
Office Phone: (�Vb 97!5- 4(e00Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name /Type: L' t-0S i "41 50 LLB OT.Js , LL-c- -- T1TL.E 1"S. A-NO C L_o S 1 r461S
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: Re14 L E5T19-"t F Q OS IN&I S ,prt S0 - nT1„E'
lIvS - R-1@-N LE (_A�vwo�5A L -1
*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 Z p ('a/4_ ®� Printed (KA-2 9-O'%J S • L E90-.
APPROVAL INFORMATION
[ ] 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 1 01 O c,
Zoning Official Date A 1 CI�-
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
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 5? 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 ❑ NO
Is parcel on private well orc, is
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 or ublic sewer?
❑ YES Er 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 he proper Permit.
Permit # 91 o?66eo
1'ech to complete the
Viol ations:
YES ❑ NO
If so, List /rD6����A
Variance:
❑ YES Lo NO
If so, List:
Reviewer to complete the following:
7 ootage re f of Use: A
YES ❑ NO
Permitted as:
Under Section:oc
Supplementary r_egu� ons section:
Parking fornu} :,
Required spaces: 9
❑ YES ❑ NO
Items to be verified in the field:
Inspector
Notes:
Proffers:
❑ YES [-V/NO
If so, List:
SP's:
❑ YES 5 NO
If so, List:
Date:
5/1/06 Page 3 of 3