HomeMy WebLinkAboutCLE200600286 Legacy Document 2015-02-10o 6-16
Application for
Zoning Clearance
OFFICE USE ONLY ^
ning Clearance = $35 CLE # O LP
PLEASE REVIEW ALL 3 SHEETS Check # Date: d -A ' �C
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: q ( 4 ?&rce1" Ar .1 Existing Zoning }►;Q�WG�i lQ m,rner� l� !
Parcel
Parcel
(include suite or
City C6r LoRes V 1 I le State VA
zip ;act
PRIMARY CONTACT
Who should we call/write concerning this project? 1�Nr l ill h L -e-
Address :1'15 9 irJa ��h �Gt r IG, &A_ lob. CityCkfty' I04C5V l I Ie State v p'
Office Phone: 61q) ?)Q 6 - 5 :t1 Kell # Fax #113q q13-q%9 E -mail ti W C1j'11Qt' • C d l'�
APPLICANT INFORMATION �/ p r
Business Name/Type: /� 1-'1' t C( O L L
Previous Business on this site VAt_>�&r. s Nip 1 i-4-L &, ry 1 c.es
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: t✓1V�S'1Y1f�,P,✓Yf fhC Libhn -s bay- `[�S Q,ud� {��,
*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 bestppof my'' knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature C"& Printed ESfHER CASH
APPROVAL INFORMATION
[ ] ✓] Approved as proposed [ ]Approved with conditions [ ]Denied
[r] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ `J146 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 i l 1 '3 ° G
Zoning Official Date 2- t D
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 comple the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES TO
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
❑ YES ❑ NO
Is parcel on septic or public sewer?
❑ YES a /
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES P-11
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 'Fecli to complete the following:
Reviewer to complete the following:
Square footage of Use: ti
[YES ❑ NO��
Permitted as:
Under Section:• . 1 (2 8)
Supplementary regulations ecton:
Parking form i a:
l �Q
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector • I Date:
Notes:
Violations:
❑ YES [ NO
If so, List:
Proffers:
❑ YES P NO
If so, List:
Variance:
❑ YES NO
If so, List:
SP's:
❑ YES UO
If so, List:
5/1/06 Page 3 of 3