HomeMy WebLinkAboutCLE200600241 Legacy Document 2014-12-02f,
Application for &r''
Zoning Clearance'`
OFFICE USE ONLY r� r�`/
F1 Zoning Clearance = $35 CLE # "Lon [� 14.4 f
PLEASE REVIEW ALL 3 SHEETS Check # / 6.3 4. Date: /V
Receipt # 1, 2.2 $ o Staff.
PARCEL INFORMATION
Tax Map and Parcel: J v Existing Zoning
Parcel Owner: t y Pl' a r k H-O l Li)M . L% L I Da V A TQil r RwA G yr yl)
V _4�10'1
Parcel Address: 5blo Tt ret'NQ-If,Irt %d U - City lit �Z,d State IL- Zip ;4T 3 a
(include suite or floor)
PRIMARY CONTACT c l
Who should we call/write concerning this project? L4 W'ZZ. 1�' • Co e_mA� -
Address : Toq_ _,n houo,4xtlil U Cityk'f State V tt Zip 221a_0
q3q - SY0 -
' ?071 Fax # j3-& - V(n_7 9 E -mail lau roL � �i y S h eAX - Co
Office Phone: ( 6 ��4 a-
APPLICANT INI
Business Name/Type:
Previous Business on this site jl
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: -�'� -�'y1�s3, 5 Vttiriun.�o �� OgMO2':&2 !'� a1VU !� I �(b�
*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 kknowled e. I have read the conditions of approval, and I understand them, and that I will abide by them.
;Signature ` Printed LPL U rA F
APPROVAL INFORMATION
ppproved as proposed [ ]Approved with conditions Denied
[0 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.
lus site cam� /lies with the site plan asTo,f, thi date.
Notes: �
Building Official Date j C) t�
Zoning Official Date 1 1/o 0.(a
Other Official
Date
County of Albemarle llepartment of q:ommumiy Leveiupment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 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.
sea_ s�
❑ YES ["NO n,,, Will there be food preparation? 1 Hk&rj '
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO 2 4 I4
Is parcel on private well orhublic water? I
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?
MYES ❑ NO W �` �ti. o ww S ' +Kpvw►K
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 0 NO a U �"'��°�'' Y��
Will there be any new construction or renova ons?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Sri
Square footage of Use:
' YES ❑ ?�N
Permitted as:
Under Sectio
Supplementary regulations section:
�
Parking formula:
_
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
]Inspector: Date:
Notes:
Zoning Tech to complete the following:
Violations:
❑ YES ❑ NO
If so, List:
Proffers:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
5/1/06 Page 3 of 3