HomeMy WebLinkAboutCLE200600279 Legacy Document 2015-02-10Application for A`�'f
Zoning Clearance
qkn (00oY-V, 1 S.ee, &P.
OFFICE USE ONLY 700 eo _ c� -7?
7
❑_Zoning.Clearance = $35
CLE #
Check# 1Ve fee _ Date: &f fl- 2Z -040
Receipt # NO - 6e— Staff:
PLEASE. REVIEW ALL :3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: I" -/�� Existing Zoning
y� J k-i
Parcel Owner: `V ` �J, S S +
Parcel Address: ) % 4 (0 C, a r 1 \,� City �� z State Zipa a U3
(include suite or oor)
PRIMARY CONTACT �/j
0 s o- oY t�e- W C,\
Who should we call/write concerning this project? � Y � 15
Address : C JM W Y N IVY City C.� ZQ State A Zip dad{ 3 a
OfficePhone: � .$d3 -a7� Celt# q3y- yd�l'y�FaX# e YeLkca,la
�N.e�iS$4.l°'I `G1�� �a�lpll aCcs;�
APPLICANT INFO TION
Business Name /Type: 1 o n is n no u o--b on S L LQ- Or %ot C,5 �0.�ri G�`�f 0 ►'1
Previous Business on this site N o
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional i fiL f i • '
information that you can provide: r MaY-ifm ortho 5 0, -ir•E
bps �s 0�v u WVLtV--s4 ct _ 'v ZA - aces as
MO 0MZ Vk SJUS CtCl UTAI � iCb S 1,U) I I V r$ t- Wl S�C $ G S o
e ro
WR-V 1h Q \- � i us-z. most p czss l YAOK tAA is
*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.
SignatureL Printede�� SS CL J, �f
APPROVAL INFORMATION
pproved
[ t ] Approved as proposed [ L, with conditions [ ] Denied
[/I Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[y]'No physical site inspection has been done for this'clearance. Therefore, it is not a determin i a eex�son�g
Ce
site plan. Ba q'W /
[ ] This site corngl}'es with the site plan as of this date. cVi"n TCAJData Needed
M2a Notes: 6 (D — -4511, x 119
Building Official Date C (' �� o
Zoning Official Date 12:,6`j
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 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.
❑ 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 ❑ NO �+ i
ir�-s h o
Is parcel on private well or E�ien)t Sev'�n' (-P
If private well, provide He form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO a��ei1 �ra-t, leas no
Is parcel on septic o public sewer. CC_
❑ YES , NO
Will you b putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES 0 NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
'been to complete me
❑ YES Y1 NO
If so, List:
Variance:
F❑YES NO
If so, List:
Reviewer to complete th following:
Square footage of Use:
2/�ES ❑ N� �
Permitted as:
Under Section:
Supplementary regulations section: 6, a
Parking formu a:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Proffers:
❑ YES
If so, List:
aNO
SP's:
S
If so, List:
❑ NO
SIP
511106 Page 3 of 3