HomeMy WebLinkAboutCLE200600266 Legacy Document 2015-01-21Application
Zoning Clearance
OFFICE USE ONLY
ning Clearance = $35 CLE # Z006)—
PLEASE REVIEW ALL 3 SHEETS Check# 4P? l Date: // -7 -0&
Receipt # &0'7/& Staff.. M,9
PARCEL INFORMATION
Tax Map and Parcel: 06 / U n - on. 00, 13 / O G Existing Zoning AD- 9 D S 4
Parcel Owner: S
//__77 J i ty%_C -y�
Parcel Address:—/ (RR / � R City State
(include suite or floor)
Zip
b:
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : %� "7 PdsLyqad e , cSu�h Tl- City Tormoce . State�()z Zip v('�
X) N
Office Phone: (_91A) —� -�� Cell # Fax # E -mail
APPLICANT INFORMATION
Business Name/Type: 1,4 �_ 1 t,✓ I % ZS 2 =�+-r� r� el—
Previous Business on this site r Y (C i
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: AA 9a e c� ( , y S r=-) , q .vt~,A -'- , [—,y c:
*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.
SigZ Printed
AP VAL 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 ((L �
Zoning Official Date la dq 19a3.J ..M...W03
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -53
a, t3� 3
f -
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 RINO
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 ETO
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
Eka -ES ❑ NO
Is parcel on septic or public sewer?
❑ YES 01<10
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 2rN0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 'Tech to complete the following:
Violations:
❑ YES U�NO
If so, List:
Variance:
❑ YES W1 NO
If so, List:
Reviewer to complete the following: +
7 Y, e footage of Use: Y� � / ES ❑ c
Permitted as:
Under Section: Cc ) e: sa - A. ( (4j l
Supplementary regula igs section:
- (A
Parking formula- •
Required spaces: ry r �, p �� D� , AA
❑ YES [;I NO
Items to be verified in the field:
Inspector • Date:
Notes:
Proffers:
❑ YES NO
If so, List:
SP s:
YES ❑ NO
Ifs , L's t:
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