HomeMy WebLinkAboutCLE200600262 Legacy Document 2015-01-21Application for
Zoning Clearance
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OFFICE USE ONLY
oning Clearance = $35 CLE # 200 (D-" �(0
F PLEASE REVIEW ALL 3 SHEETS Check # ''�c;� ) Date: JO - �1- 0
Receipt # J &:9JD a Staff. &Q
PARCEL INFORMATION
Tax Map and Parcel: �7 0 t '" 00 -0 " 036/7' n Existing Zoning
Parcel Owner 11 r r �L LC_
Parcel Address: Cco76� city I
CAW Iut"- syi I state y A Zip 22911
(include suite or floor) �..71-a 100
PRIMARY CONTACT
Who should we call/write concerning this project? 1; (uSl A et.$0 to
Address :(bbT � , �e 5ovi Aw &t? (bo city Ow LoiAesvi I k State yA
Zip Z 2911
Office Phone: 9-79-C)() 41 Cell #qJ1 -b1b9 -3 Fax49 -71 -603 I E -mail K a( meAQao k- Covv\
APPLICANT INFORMATION
Business Name /Type: (�.iSiDt.t $Tu Ctc � PL-C LAAA) i:T(M
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: 3 a-f~Ear'vlegS a Ma*imut M Z -5f L1 f t'VI.P.vtn 6e"rs,
*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 o a kn- e. I have read the conditions of appro�valal, and I understand them, and that I will abide by them.
Signature Printed 1C i l �l.,rj/ I % son
APPROVAL INFORMATION
[ ] Approved as proposed [ ] App
[ ] Backflow prevention device and /or current test data i
[ ] No physical site inspection has been done for this c16
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Zoning Official
[ ] Denied
?77 -4511, x119.
nation of compliance with the existing
I
County of Albemarle Department of Community Development
401 MFIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
0
Intake to complete the following:
❑ YES l NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [INO
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 R'-NO
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
2--YES ❑ NO
Is parcel on septic or public sewer?
❑ YES L2"'NO
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 #
Zoning Tech to complete the following:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
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:
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