HomeMy WebLinkAboutCLE200600267 Legacy Document 2015-01-21u�
Application for
Zoning Clearance
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OFFICE USE ONLY
Elloning Clearance = $35 CLE # 2-00 (P ) J ---7
PLEASE REVIEW ALL 3 SHEETS , Check# Date: 11M- ' -f"J(A
1 4 !J' Co —Receipt # Ct�r� ��. � Staff:
PARCEL INFORMATION
T x Ma an Parcel:. r; � Existing. Zoning..
over �4l
Parcel Owner:
1�P1� In r`a a r� (� A1( i2191(f3 . .4 F� "Li 1 iPp rsr, r 1� hfhGit
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address • 6�> f i3 U )L�� ±Ulmd
City (Ir)( -A L'tL �tate V ZIP
Office Phone: Cell #
APPLICANT INFORMATION
Business Name/Type:- �t-A Nk j
Previous Business on this site
Fax # 3nU- — h E -mail
Mc� i j A A-,A aFD n
.. i - V i i •--r^ r r n ! n r1 6 . l� . Lb
Describe -the proposed business, including use, number of employees,- number of shifts,.-available parking spaces and any
additional-information- thatyyoucan.provide- u I Zv
r' c 'n 'C2
EEO P 86C -0
*This Clearance will only be vall on the parcel for which it is approved. If you change, intensify or move the -use to a new location, -anew Zoning
Clearance will be required.
I true. and__ that
the best r ofmy .owner s permission to use the. space indicated on this application I also certify that the- information provided
I hereby cerEi that own or have the owner'
e_ I have .read -the. conditions. of approval,. and-Iunderstand_them > amd- thatI. will. abide, by them
Signature Printed 'u-C
/
APPROVAL INFORM /ION
[ ] 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 cpmplies with the site plan as of this date.
Notes: ?1_0 `t
Building Official Date i ( t'l k 6 --c-
Zoning Official Date (` I
Other Official Date
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page2.of 3.
Intake to complete t e following:
.YES 0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [K 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
g YES ❑ NO
Is parcel on private well or ublic
If private well, provide-Health Department-form.
Zoning review can- not begin until we-receive approval- from Health .
Dept. FAX DATE
YES ❑ NO-
s parcel on septic or ublic sewer
YES. ❑- NO
Will you_be.putting -up anew sign -of any. kind? If so,.obtain.proper
Sign-permit... r Q OLCIa— /Vo �_
Permit # - <' n n C-yu
❑_ YES 0%
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
15;00 (e= aga -31tc- V4AA;15
5onin2 Tech to complete the
Violations:
[:[YES ❑ NO
Tf— T ict-
Reviewer to complete the following:
Square footage of Use: )4-10 0
YES ❑ NO I
Permitted as: � C gry - V�C(c(,ei�'Lf aP
Under Section: a t ola`• t 104-0
Supplementary regulations section:
Parking fo u
Required spaces
�44,&d -rc
YES- ❑- NO
Items to be-verified in- thefield:
Inspector • Date:
Notes:
Proffers:
Q YES E[ NO
Variance:
❑ YES ❑. NO
If so � I�Is�
SP's: n r '
❑ YES ❑ NO
If so, List:
ui 5 -5"
5 /1 /06-Page-3 of