HomeMy WebLinkAboutCLE201200143 Legacy Document 2012-07-10AP _ r� a ,�f d . _ _
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Zoning Clearance = $35
Check Date:
vok
PLEASE REVIEW ALL 3 SHEETS
Receipt Staff: ZM
PARCEL INFORMATION
Tax Map and Parcel: O(a / )A(o -0 L - QA- 00- 8.2v -/J - J3 - 1Q Existing Zoning NlEY6a0o�1,Noao �KODrc
Parcel Owner: My iag
Parcel Address:34io LiICZQo3dxz_ ML, CityCAAA-U11X5VJ"C State )/A Zip ZZ.90/
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 5UF A-L.gg tCeh-b=
Address :s'Z.ss� )'P' VZ v La �1 4Ag-&r City d'LU.&-_ State VA Zip ZZ901
Office Phone: Cell tl3," Fax ri 973.0'732. E -mail 3V 9- e. 0 11+
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name INTew business
Business Name /Type: M AINA LQ57—VT07C
Previous Business on this site Ji1<S JL.9 SNV A0Q; CoProarrl a I4
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: W..OoaL /yCl ,�f z7AC./JR.T7r '�j/+1�_ •zip
ei/1Awim,6 �/1Go1L� J Awiyl" LL 455-IU Of- !SS 7 -0CUJ77 F✓1Qi
"This Clearance ilf only be valid on the pace for which it is approved. Ifyou 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 trae and accurate to the est of my lalowledgl have read the conditions of approval, and I understand them, and that I will abide by there.*
Signature Printed ..SV9 /4-, ALrsg.Ec_R -
_ PROVA:L INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] 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 --I((.
Zoning Official Date ��9
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5532 Fax: (434) 972 -4126
Revised 04/28/03, 10/13/09 Page 2 of 3
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?; ;: ir.K; 'o.".oss;i3'3xe"ithe x�siiiYtilt ��:
Is u n LI, HI or PDIP zoning? If
s� so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(5>
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, FADS DA'Z'E
, vl.eTfe-T to e ;'rnpl.et : th— e//"":�;3//O v BA``s :
Square footage of Use: I x (o USi
'n p
Qr/ N I' UI (( b f� � h nitted as: nn // �� pp�� . J
Under Section: d� A ' W a.. yj (a dl'J 6f-
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on'private well o ublic orate
If private well, provide Hea Department form.
Zoning review can not begin until we receive approval from Health Required spaces: qLf
Dept. FAX DAT E J
Y/N
Circle the one that applies. _ Items to be verified in the field:
Is parcel on septic oy 'ublic sewe -
Y/N
Will you be putting up a new sign of any Lind? If so, obtain proper
Sign permit. %'� r' 'ec-. DC-rexA14CO
Permit Inspector
9/ N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit
7nnina to cornnlete the followin6:
Wu V1 J may ew, 06 � I
Violations:
Y/ N
If so, List: In�
UI,�J
+" :
Y/ N
If so, List:
CO(.Clc of D l (7 r
1 AAA a � �"'��/���'tt
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nw
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: ,
SAP's N[,�f
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Revised 04/28/08, 10/13/09 Page 3 of 3
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