HomeMy WebLinkAboutCLE200600248 Legacy Document 2014-12-02r. Application for A`9
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Zoning Clearance G[��
oning Clearance = $35
OFFICE USE ONLY �)
CLE # (3( — a '-
Check # _�('� Date: z -q-09
PLEASE REVIEW ALL 3 SHEETS
Receipt # 4n,-9:3 -7 Q Staff: In(<
PARCEL INFORM//}ATI]ON
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Tax Map and Parcel: D' J,5 C.� "° ®�)�(l t� �7 �� P IDS
-t J Existing Zoning
Parcel Owner:.• -i'?L (.��1® -C� / ✓l �'f�,(/� �C.-�
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Parcel Address: I83Jr $ r-M 1 NOLETRAJL_City _t✓ PeRL.ATC SV StaE �%A Zip zzgol
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Roy b.
Address: R O . $ k 3 Z-Zq City W lt'f N F.560%0 State VA Zip2Z98p
Office Phone: , (60-UogI Cell # Fax # E -mail Y' LDr'Ol)S�C cohStiz
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APPLICANT INFORMATION.
Business Name /Type: R D, 5 PROU-5 f,. C.ON5TRVC.T 100 GO.. 1 NC-
Previous Business on this site C- ) I T'O L L1G k l Al&
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that,you can provide: 14OMe 'BV►LDER t +� L GOI!'STRt3c 10 d*
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Apimnewfia- Rre L 0JG 02, `t'�:aT _ "-mapo a r� i,�_�. roR, h P T
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*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 �, �.,ti,�A Printed 12,o f
APPROVAL INFORMATION
[ ✓] pproved as proposed [ ] Approved with conditions [ ] Denied
[ j�ackflow 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 i O
Zoning Official Date
T
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/l/06 Page 2 of 3
Intake to complete the following:
❑ YES -16
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 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 0,Wb
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑KYES ❑ NO
Is parcel on septic or public sewer?
❑ YES FLPNI
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning Tech to complete the followinL7:
Violations:
❑ YES EV NO
If so, List:
Variance:
F-1 YES' [tG NO
If so, List:
Reviewer to complete the following:
Square footage of Use: 5
e
AYES ❑ N� nnN
Permitted as:
Under Section:
Supplementary re gu ions section:
Parking formula:
4A
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
❑ YES VNO
If so, List:
SP's:
❑ YES D�/ O
If so, List:
511106 Page 3 of 3