HomeMy WebLinkAboutCLE200600284 Legacy Document 2015-02-10Application for
Zoning Clearance
V v - 1'�J
® Zoning Clearance = $35
OFFICE USE ONLY
CLE # _ Q
PLEASE REVIEW ALL 3 SHEETS
Check # 110 Date:
Receipt # 4 oZW7 Staff•
PARCEL INFORMATION
Tax Map and Parcel: t0 J 00- 00—w— �(� y�a , Existing Zoning I
Parcel Owner: RA I M LI N LLC--,
Parcel Address: ?2Z c,,) eyt 2.`p , City _Ct,,wL t> nt,, lLe_ State V'/9 Zip 2LO0&o
(include suite or floor)
•PRIMARY CONTACT
Who should we call /write concerning this project? _ Ck gb [-1;� SAC�nc+r
Address: 722 Wcs+ Q:oP7 Spite 6 City Ciorto+}rsv,;lye State 1/,q Zip 22`t0t,
Office Phone: !{3 i73 -twy�( Cell# Fax #_y3+t- q?I -)7Yq E- mail - -C", C,>Fi��TSP C�h
APPLICANT INFORMATION
Business Name/Type: Al beMArl e
Previous Business on this site 'T c, ro-v f5 , !�^-r
Describe the proposed business, including use, number of employees, number of shifts, available ]larking spaces and any
additional information that you can provide: iq evt
gackftw ev>ice
*This Clearance will only be valid on the parcel for which it is approved. I f you change, inten i fyere>I'� ` tie' 6 Da to i+ w oning
Clearance will be required.
Ctfntact ACSA 977 -4511, x 119
1 hereby certify that I own or have the owner's permission to use the space indicated on this app !ca ion. i also certify that the information provided
is true and accure to the best of my knowledge. 1 have read the conditions of approval, and I understand them, and that 1 will abide by them,
Signature Printed K14Z4 •1Ge ..
AOVAL INFORMATION
[V] ],Approved as proposed [ ] Approved with conditions [ ] Denied
ckflow prevention device and /or current test data needed for (his site. Contact ACSA, 977 -4511, xl 19.
Pte No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
plan.
[ j This site complies with the site plan as of this date.
Notes:
Building Official Date '
Zoning Official Date _� b
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to complete the following:
❑ YES MINO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's R;N>O ER) packet.
F-1 YES
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
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
Fj—�,IES ❑ NO
Is parcel on septic or public sewer?
❑ YES ❑,N'O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
ER"Y"ES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Gonmff,'Yech to complete the
v o tons:
LY YES ❑ NO
If so, List:
Variance:
❑ YES [E' NO
If so, List:
4z
Reviewer to complete the following:
Square footage of Use: eo
LltriE teSd El NO
as: �kD `
Under Section: ,)4 • a.
Supplementary regulations section:
G
Parking formula: J
I /�
Required spaces:
LOT
❑ YES ❑ NO
Items to be ver fied in the field:
Inspector :
Notes:
Proffers:
❑ YES [9-NO
If so, List:
SP's:
❑ YES NO
If so, List:
Date:
5/1/06 Page 3 of 3