HomeMy WebLinkAboutCLE200600301 Legacy Document 2015-02-10Application for
Zoning Clearance
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County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 r
5/1/06 Page 2 of V
OFFICE USE ONLY �t
❑ Zoning Clearance = $35
CLE #
Check #—i Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: / � —� %, �� -71 34 1' Existing Zoning
Parcel Owner �f �L // G J �/ G C
loS� >�c�rE.f' •T�Ff �tS°5� �1/ �i['�J y C.�/�vE'Lz,TTE_S ✓dGLE i�i�' �� � f!
Parcel Address: /cep City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address :7�9 LAG z.;— '-52 y� City C.Al E7 State``
\\11166-
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Office Phone: 2-Scell # Fax # � lYE -mail iy!✓ J/,
APPLICANT INFORMATION
Business Name /Type:C4X2)I(,, 46& y AR.5.5c6G' LXZ.6TTF.�SVlLG
Previous Business on this site A�1i1
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: es CG= -' ��S- YEe5 "
D/'� %GE v"x -s 2 — _e' - m_ni- 'A;qI -- .zW-Al2>i ; dJK*'IAACI- .9 VA iZ Ae2 AIn
*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 owne '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 m kn edge. I have read the conditions of approval, and I understand them, and that Iwill abide by them.
Signature Printed ACet✓C/e
APiPRO AL INF&MATION
[ ✓ ✓] Approved as proposed [ ] Approved with conditions [ ] Denied
[VrBackflow 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 al I o (,
Zoning Official Date 2 "
Other Official Date
vy
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 r
5/1/06 Page 2 of V
Intake to plete the following:
YES co �N0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 12/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
Is parcel on private well otalth c water?
If private well, provide H epart nt for m.
Zoning review can not bel a receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO /��
Is parcel on septic o pr ublic sewer?
❑ YES 2/NO �.
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
[YES ❑ NO
Will there be any new construction or renovations?
If so, obtai the proper Permit.
Permit # b(Q -�6 �L J ],,q 0�
GoninLy Tech to complete the tollowin>?:
Violations:
F-1 YES P NO
If so, List:
Variance:
❑ YES NO
If so, List:
Reviewer to complete the following:
Square footage of Use: r�i� 4
DYES ❑ N
Permitted as: VI�O('f ,
Under Section: -�26A
Supplementary regulations section:
Parking formula:
i
Required spaces: 14AK)
1
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
511106 Page 3 of 3